Prognosis of respiratory tract infections in primary care

The same year that Alexander Fleming and colleagues received the Nobel prize for work on the antibacterial properties of penicillin (1945), Fleming warned against the risk of bacterial resistance. In Europe today, about 25 000 lives are lost each year as a direct consequence of resistant bacteria.1 Frequent outpatient prescribing of antibiotics is associated with high levels of resistant Streptococcus pneumoniae in comparisons between nations.2 Unnecessary use of antibiotics could be greatly reduced by identifying those patients who would benefit from such treatment. Two linked studies on the prognosis of respiratory tract infections provide new and practical information for the primary care doctors who must guide patients through their treatment choices for these common infections.3 4

In a systematic review (doi:10.1136/bmj.f7027), Thompson and colleagues explored the duration of various respiratory tract infections in children up to 18 years of age attending primary care.3 Reliable and scientifically sound prognostic information is essential to help reassure worried parents that antibiotics may not be necessary. This study included 23 randomised controlled trials and 25 observational studies. Rather than average illness duration—the metric used by the …