Post-consultation acute respiratory tract infection recovery : a latent class-informed analysis of individual patient data
Hounkpatin, Hilda (University of Southampton)
Stuart, Beth (University of Southampton)
Zhu, Shihua (University of Southampton)
Yao, Guiqing (University of Leicester)
Moore, Michael (University of Southampton)
Löffler, Christin (Rostock University Medical Center)
Little, Paul (University of Southampton)
Kenealy, Timothy (University of Auckland)
Gillespie, David (Radcliffe Observatory Quarter)
Francis, Nick (University of Southampton)
Bostock, Jennifer (King's College London)
Becque, Taeko (University of Southampton)
Arroll, Bruce (University of Auckland)
Altiner, Attila (University of Leicester)
Alonso-Coello, Pablo (Institut d'Investigació Biomèdica Sant Pau)
Hay, Alastair D. (University of Bristol)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	There is a lack of evidence regarding post-consultation symptom trajectories for patients with respiratory tract infections (RTIs) and whether patient characteristics can be used to predict illness duration. To describe symptom trajectories in patients with RTIs, and assess baseline characteristics and adverse events associated with trajectories. Design and setting The study included data about 9103 adults and children from 12 primary care studies. A latent class-informed regression analysis of individual patient data from randomised controlled trials and observational cohort studies was undertaken. Post-consultation symptom trajectory (severity and duration), re-consultation with same or worsening illness, and admission to hospital were assessed. Results In total, 90% of participants recovered from all symptoms by 28 days, regardless of antibiotic prescribing strategy (none, immediate, and delayed antibiotics). For studies of RTI with cough as a dominant symptom (n= 5314), four trajectories were identified: 'rapid (6 days)' (90% of participants recovered within 6 days) in 52. 0%; 'intermediate (10 days)' (28. 9%); 'slow progressive improvement (27 days)' (12. 5%); and 'slow improvement with initial high symptom burden (27 days)' (6. 6%). For cough, being aged 16-64 years (odds ratio [OR] 2. 57, 95% confidence interval [CI] = 1. 72 to 3. 85 compared with <16 years), higher presenting illness baseline severity (OR 1. 51, 95% CI = 1. 12 to 2. 03), presence of lung disease (OR 1. 78, 95% CI = 1. 44 to 2. 21), and median and above illness duration before consultation (≥7 days) (OR 1. 99, 95% CI = 1. 68 to 2. 37) were associated with slower recovery (>10 days) compared with faster recovery (≤10 days). Re-consultations and admissions to hospital for cough were higher in those with slower recovery (ORs: 2. 15, 95% CI = 1. 78 to 2. 60 and 7. 42, 95% CI = 3. 49 to 15. 78, respectively). Older patients presenting with more severe, longer pre-consultation symptoms and chronic lung disease should be advised they are more likely to experience longer post-consultation illness durations, and that recovery rates are similar with and without antibiotics.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Antibiotics ; General practice ; Latent class analysis ; Respiratory tract infections
Publicat a:	British journal of general practice, Vol. 73 Núm. 728 (march 2023) , p. E196-E203, ISSN 1478-5242

DOI: 10.3399/BJGP.2022.0229
PMID: 36823057

8 p, 166.8 KB

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