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1.  Predictors of positive radial margin status in a population-based cohort of patients with rectal cancer 
Current Oncology  2008;15(2):98-103.
Background
Surgical margin status is an important predictor of risk of relapse among patients with rectal cancer.
Methods
Patients referred to the British Columbia Cancer Agency for consideration of adjuvant therapy for rectal adenocarcinoma were included. Predictors of margin positivity were determined from uni- and multivariate analysis.
Results
Among 340 patients, 83% had negative resection margins. In 268 patients with resectable tumours, a significantly higher rate of margin positivity was observed in low rectal tumours (32.2%) as compared with mid-rectal (3.9%) and high rectal (14.3%) tumours. Among 59 patients with locally advanced rectal cancer treated with preoperative radiation (with or without chemotherapy), 32% with low tumours had margin positivity. Of patients with T4 tumours, 50% (11/22) had a positive resection margin.
Conclusions
In a population cohort, distal-third rectal location, locally advanced presentation, and T4 cancer represent subgroups for whom further improvement in therapy is required.
PMCID: PMC2365482  PMID: 18454185
Rectal cancer; predictors of surgical margin status
2.  2004 update of BTS pneumonia guidelines: what's new? 
Thorax  2004;59(5):364-366.
doi:10.1136/thx.2004.024992
PMCID: PMC1747016  PMID: 15115857
3.  Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study 
Thorax  2003;58(5):377-382.
Background: In the assessment of severity in community acquired pneumonia (CAP), the modified British Thoracic Society (mBTS) rule identifies patients with severe pneumonia but not patients who might be suitable for home management. A multicentre study was conducted to derive and validate a practical severity assessment model for stratifying adults hospitalised with CAP into different management groups.
Methods: Data from three prospective studies of CAP conducted in the UK, New Zealand, and the Netherlands were combined. A derivation cohort comprising 80% of the data was used to develop the model. Prognostic variables were identified using multiple logistic regression with 30 day mortality as the outcome measure. The final model was tested against the validation cohort.
Results: 1068 patients were studied (mean age 64 years, 51.5% male, 30 day mortality 9%). Age ⩾65 years (OR 3.5, 95% CI 1.6 to 8.0) and albumin <30 g/dl (OR 4.7, 95% CI 2.5 to 8.7) were independently associated with mortality over and above the mBTS rule (OR 5.2, 95% CI 2.7 to 10). A six point score, one point for each of Confusion, Urea >7 mmol/l, Respiratory rate ⩾30/min, low systolic(<90 mm Hg) or diastolic (⩽60 mm Hg) Blood pressure), age ⩾65 years (CURB-65 score) based on information available at initial hospital assessment, enabled patients to be stratified according to increasing risk of mortality: score 0, 0.7%; score 1, 3.2%; score 2, 3%; score 3, 17%; score 4, 41.5% and score 5, 57%. The validation cohort confirmed a similar pattern.
Conclusions: A simple six point score based on confusion, urea, respiratory rate, blood pressure, and age can be used to stratify patients with CAP into different management groups.
doi:10.1136/thorax.58.5.377
PMCID: PMC1746657  PMID: 12728155
4.  PNEUMOCOCCAL AND INFLUENZA VACCINATION: CURRENT SITUATION AND FUTURE PROSPECTS 
Thorax  2002;57(Suppl 2):ii24-ii30.
PMCID: PMC1766003  PMID: 12364707
5.  Pneumonia and pregnancy 
Thorax  2001;56(5):398-405.
doi:10.1136/thorax.56.5.398
PMCID: PMC1746055  PMID: 11312410
6.  Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines 
Thorax  2001;56(4):296-301.
BACKGROUND—Since the last British study of the microbial aetiology of community acquired pneumonia (CAP) about 20 years ago, new organisms have been identified (for example, Chlamydia pneumoniae), new antibiotics introduced, and fresh advances made in microbiological techniques. Pathogens implicated in CAP in adults admitted to hospital in the UK using modern and traditional microbiological investigations are described.
METHODS—Adults aged 16 years and over admitted to a teaching hospital with CAP over a 12 month period from 4 October 1998 were prospectively studied. Samples of blood, sputum, and urine were collected for microbiological testing by standard culture techniques and new serological and urine antigen detection methods.
RESULTS—Of 309 patients admitted with CAP, 267 fulfilled the study criteria; 135 (50.6%) were men and the mean (SD) age was 65.4 (19.6) years. Aetiological agents were identified from 199 (75%) patients (one pathogen in 124 (46%), two in 53 (20%), and three or more in 22 (8%)): Streptococcus pneumoniae 129 (48%), influenza A virus 50 (19%), Chlamydia pneumoniae 35 (13%), Haemophilus influenzae 20 (7%), Mycoplasma pneumoniae 9 (3%), Legionella pneumophilia 9 (3%), other Chlamydia spp 7 (2%), Moraxella catarrhalis 5 (2%), Coxiella burnetii 2 (0.7%), others 8 (3%). Atypical pathogens were less common in patients aged 75 years and over than in younger patients (16% v 27%; OR 0.5, 95% CI 0.3 to 0.9). The 30 day mortality was 14.9%. Mortality risk could be stratified by the presence of four "core" adverse features. Three of 60 patients (5%) infected with an atypical pathogen died.
CONCLUSION—S pneumoniae remains the most important pathogen to cover by initial antibiotic therapy in adults of all ages admitted to hospital with CAP. Atypical pathogens are more common in younger patients. They should also be covered in all patients with severe pneumonia and younger patients with non-severe infection.


doi:10.1136/thorax.56.4.296
PMCID: PMC1746017  PMID: 11254821
7.  Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community 
Thorax  2001;56(2):109-114.
BACKGROUND—Acute lower respiratory tract illness in previously well adults is usually labelled as acute bronchitis and treated with antibiotics without establishing the aetiology. Viral infection is thought to be the cause in most cases. We have investigated the incidence, aetiology, and outcome of this condition.
METHODS—Previously well adults from a stable suburban population consulting over one year with a lower respiratory tract illness were studied. For the first six months detailed investigations identified predetermined direct and indirect markers of infection. Evidence of infection was assessed in relation to presenting clinical features, indirect markers of infection, antibiotic use, and outcome.
RESULTS—Consultations were very common, particularly in younger women (70/1000 per year in previously well women aged 16-39 years), mainly in the winter months; 638 patients consulted, of whom 316were investigated. Pathogens were identified in 173 (55%) cases: bacteria in 82 (Streptococcus pneumoniae 54, Haemophilus influenzae 31, Moraxella catarrhalis 7), atypical organisms in 75 (Chlamydia pneumoniae 55, Mycoplasma pneumoniae 23), and viruses in 61 (influenza 23). Seventy nine (24%) had indirect evidence of infection. Bacterial and atypical infection correlated with changes in the chest radiograph and high levels of C reactive protein but not with (a) the GP's clinical assessment of whether infection was present, (b) clinical features other than focal chest signs, and (c) outcome, whether or not appropriate antibiotics were prescribed.
CONCLUSIONS—Over 50% of patients have direct and/or indirect evidence of infection, most commonly bacterial and atypical pathogens, but the outcome is unrelated to the identified pathogens. Many patients improve without antibiotics and investigations do not help in the management of these patients. GPs can reassure patients of the causes and usual outcome of this self-limiting condition.


doi:10.1136/thorax.56.2.109
PMCID: PMC1746009  PMID: 11209098
8.  A national confidential enquiry into community acquired pneumonia deaths in young adults in England and Wales 
Thorax  2000;55(12):1040-1045.
BACKGROUND—The aim of this study was to describe the frequency, causal pathogens, management, and outcome of a population of young adults who died from community acquired pneumonia (CAP).
METHODS—Pneumonia deaths in England and Wales in adults aged 15-44 were identified between September 1995 and August 1996. Patients with underlying chronic illness including HIV infection were excluded. Clinical details for each case were collected from the hospital and general practitioner records.
RESULTS—Death from CAP was identified in 27 previously well young adults (1.2 per million population per year). Twenty were known to have consulted a GP for this illness. Nine received antibiotics before hospital admission. A causative pathogen was identified in 17 cases (Streptococcus pneumoniae in eight). Bacteraemia was present in seven. All patients who reached a hospital ward received antibiotics (69% within two hours of admission). The British Thoracic Society antibiotic guidelines for severe CAP were followed in only 10 cases. Cardiac arrest at home or on arrival at hospital occurred in six cases, one of whom was successfully resuscitated. Of the remaining 21 patients, 71% had two or more markers of severe CAP. All 22 who were admitted reached an intensive care unit, but 11 of these required transfer to another hospital for some aspect of intensive care. One third of patients died within 24hours of presenting to the hospital.
CONCLUSIONS—Death from CAP in previously fit young adults still occurs. While some deaths might be preventable by better patient management, most are unlikely to be preventable by current management practices.


doi:10.1136/thorax.55.12.1040
PMCID: PMC1745667  PMID: 11083890
9.  Antibiotic prescribing in the community 
Thorax  2000;55(8):722.
doi:10.1136/thorax.55.8.722a
PMCID: PMC1745820  PMID: 10950721
10.  Severity prediction rules in community acquired pneumonia: a validation study 
Thorax  2000;55(3):219-223.
BACKGROUND—The British Thoracic Society (BTS) developed a rule (BTSr) based on severity criteria to predict short term mortality in adults admitted to hospital with community acquired pneumonia (CAP). However, neither the BTSr nor a recent modification of it (mBTSr) have been validated in the UK. A case-control study was conducted in a typical UK population to determine the clinical factors predictive of mortality and to assess the performance of these rules.
METHODS—Cases were drawn from all patients with CAP who died in 1997 in five large hospitals in the Mid Trent area. Controls were randomly selected from survivors. Factors associated with mortality were identified following review of medical case notes and performance of the severity prediction rules assessed.
RESULTS—Age >65 years, temperature <37°C, respiratory rate >24 breaths/min, mental confusion, urea concentration of >7 mmol/l, sodium concentration of <135 mmol/l, and the presence of a pleural effusion, all determined on admission, were independently associated with in-hospital mortality on multivariate analysis. The BTSr was 52% sensitive and 79% specific in predicting death while the mBTSr displayed 66% sensitivity and 73% specificity.
CONCLUSIONS—The value of three of the four factors (presence of mental confusion, raised respiratory rate, raised urea) used in the mBTSr as predictors of mortality is confirmed. However, the BTSr and mBTSr did not perform as well in this validation study which included a high proportion (48%) of elderly patients (⩾75 years) compared with the derivation studies.


doi:10.1136/thorax.55.3.219
PMCID: PMC1745710  PMID: 10679541
11.  Do hospital physicians have a role in reducing antibiotic prescribing in the community? 
Thorax  2000;55(2):153-158.
doi:10.1136/thorax.55.2.153
PMCID: PMC1745680  PMID: 10639535
12.  Introduction 
Thorax  1999;54(6):538-539.
PMCID: PMC1745493  PMID: 10335009
13.  Symptoms, signs, and prescribing for acute lower respiratory tract illness. 
BACKGROUND: Most patients who consult with acute lower respiratory symptoms receive antibiotics, usually without evidence of significant infection. The physical signs at presentation of acute lower respiratory tract illness and the rate at which symptoms resolve and normal activities recover is not well documented. AIM: To examine in patients with lower respiratory tract infection (LRTi), their physical signs at presentation, their relationship to antibiotic prescribing, and symptom resolution and resumption of normal activities. DESIGN OF STUDY: Analysis of data collected prospectively during presentation of acute LRTi in primary care and from patient symptom diary cards. SETTING: Forty GPs who were members of an informal Community Respiratory Infection Interest Group recruited 391 patients to the study. METHOD: Information was collected on pulse, oral temperature, respiratory rate, abnormalities on auscultation, and details of any antibiotic prescription. Patients completed symptom diary cards for the following 10 days. RESULTS: Of the 391 patients who consulted 71% received antibiotics. A minority had abnormal physical signs: 17% had a pulse greater than 90 bpm, 15% a respiratory rate greater than 20 breaths per minute, 4% had a temperature greater than 38 degrees C, and 25% had an abnormality on auscultation. Antibiotic prescribing was more common in the presence of abnormal chest signs (odds ratio = 8.71, 95% confidence interval = 3.69-20.61) or discoloured sputum (OR = 2.67, 95% CI = 1.57-4.56). Ten days after consultation, 58% of patients were still coughing and 29% had not returned to normal activities. CONCLUSION: Abnormal physical signs at presentation do not explain the high rates of antibiotic prescribing nor do they predict persisting cough and functional impairment at 10 days. Reconsultation for the same symptoms within a month is common and is strongly related to persisting cough, but not abnormalities at presentation.
PMCID: PMC1313947  PMID: 11255897
15.  Impact of management guidelines on the outcome of severe community acquired pneumonia 
Thorax  1997;52(1):17-21.
BACKGROUND: Ten years ago we published a study of 50 adults with severe community acquired pneumonia admitted to our intensive care unit and subsequently introduced guidelines for the management of severe community acquired pneumonia which are largely in accordance with those of the British Thoracic Society. The results of a follow up study are now reported in order to assess their impact on the outcome of this disease. METHODS: Fifty seven cases of severe community acquired pneumonia admitted to our ICU between 1984 and 1993 were studied. Causal pathogens, clinical and laboratory features of severity, antibiotic therapy and mortality were studied and, where possible, compared with results from the previous study. RESULTS: Streptococcus pneumoniae, Legionella pneumophila and Staphylococcus aureus were the most frequent causes of severe community acquired pneumonia, as in the previous study. The intensity of microbial investigation has increased, particularly with regard to pneumococcal and Legionella antigen testing, the latter allowing earlier diagnosis of Legionella infection than previously. In spite of this, no pathogen was identified in 33% of cases compared with 18% previously. Indices of severity of illness were widely recognised, and a decrease in unplanned transfers to the ICU following "unexpected" cardiorespiratory arrest from 25% to 7% (p < 0.02) was found. Antibiotic therapy largely reflected guideline recommendations with 98% receiving a beta-lactam agent and 91% erythromycin. The overall mortality was 58% compared with 54% previously. CONCLUSIONS: Management guidelines for severe community acquired pneumonia have been widely adopted but without a reduction in mortality in our hospital. Factors other than early diagnosis, appropriate antibiotics, or prompt ICU transfer may influence the outcome in severe community acquired pneumonia. 



PMCID: PMC1758402  PMID: 9039234
16.  How do general practitioners respond to reports of abnormal chest X-rays? 
General practitioners (GPs) in the UK have long had direct access to hospital radiological services, which in theory shortens investigation time and improves the quality of service. Chest X-rays (CXRs) account for a substantial proportion of requests, and we investigated what happened when an abnormality was detected. In one year, 204 GPs in the Nottingham area requested CXRs in 605 patients. 362 were reported normal, 165 abnormal but hospital follow-up not indicated and 71 abnormal with radiological follow-up or hospital referral indicated (mass lesion suspicious of tumours 27, infective shadowing 35, other 9). 64 of the 71 were seen in hospital within three months, and in those with suspected cancer the median time to follow-up was 20 days. These results show that GPs do act on the results of abnormal CXRs, but only 37% of those with a mass suspicious of cancer were seen in hospital within two weeks as recommended by the British Thoracic Society. Time might be saved if GPs agreed to direct referral from the radiology department to respiratory physicians.
PMCID: PMC1297353  PMID: 10645291
17.  Antibiotic resistant Streptococcus pneumoniae. 
Thorax  1996;51(Suppl 2):S45-S50.
Images
PMCID: PMC1090706  PMID: 8869352
18.  Radiographic features of staphylococcal pneumonia in adults and children. 
Thorax  1996;51(5):539-540.
BACKGROUND: Clinical and laboratory features do not accurately correlate with the cause of community acquired pneumonia. A study was performed to examine whether the radiographic features of staphylococcal pneumonia are sufficiently distinct to aid early diagnosis. METHODS: The chest radiographs of 34 patients (including eight children) with proven staphylococcal pneumonia were reviewed by two experienced observers using methods described previously. Features on presentation and follow up were noted. RESULTS: The most striking features were the presence of multilobar consolidation on presentation, cavitation, pneumatocoeles and spontaneous pneumothorax, together with a tendency to radiographic deterioration after admission in both adults and children. Some of these features are much less common with other causes of community acquired pneumonia. However, most of the cases did not have these classic features. CONCLUSIONS: The presence of certain radiographic features, including multilobar shadowing, cavitation, pneumatocoeles, and spontaneous pneumothorax, are seen with staphylococcal pneumonia in adults and children, but their absence does not exclude the diagnosis.
PMCID: PMC473606  PMID: 8711686
19.  Commentary: pleural empyema and malignancy--another dimension. 
Thorax  1996;51(1):107-108.
Images
PMCID: PMC472816  PMID: 8658359
20.  The influence of antibiotics and other factors on reconsultation for acute lower respiratory tract illness in primary care. 
BACKGROUND: Antibiotics are prescribed to the majority of patients consulting their general practitioner (GP) for lower respiratory tract illness (LRTi). A common reason for prescription is the belief that antibiotics reduce re-attendance; a motive supported by the high reconsultation rates for this largely self-limiting illness. Information about reconsultation following treatment of LRTi, and the factors that influence it, is scarce. AIM: To explore factors associated with reconsultation after initial management of LRTi. METHOD: Analysis of data collected prospectively during presentation of acute LRTi in primary care. RESULTS: Seventy-six per cent of 518 patients were prescribed antibiotics, and 30% reconsulted for similar symptoms within the next 28 days (29% of those who were given antibiotics and 33% of those who were not). Forty-one per cent of patients who had seen their GP 15 or more times in the previous two years reconsulted, compared with 13% of those who had made fewer than five visits. Reconsultation was more common in patients with a history of underlying disease (38.6% versus 24.3%) and in patients who reported dyspnoea (41.5% versus 24.3%). CONCLUSION: Reconsultation is common in acute LRTi and is associated with a heightened consulting habit prior to the index consultation, the presence of previous ill health, and dyspnoea. It appears not to be influenced by prescribing antibiotics.
PMCID: PMC1410080  PMID: 9463983
21.  Reducing reconsultations for acute lower respiratory tract illness with an information leaflet: a randomized controlled study of patients in primary care. 
BACKGROUND: General practitioners (GPs) prescribe antibiotics to three-quarters of patients who consult with a lower respiratory tract illness (LRTi). In spite of this management, around a quarter of patients reconsult for the same symptoms within a month. AIM: To investigate the impact of providing a simple leaflet regarding the natural history of lower respiratory tract symptoms on reconsultation rates for previously well adults presenting to their GP with an LRTi. METHOD: Seventy-six GPs studied 1014 previously well adults presenting with an illness defined as an LRTi. Management was left to the GP's discretion. Half of the patients were randomly allocated to receive an information leaflet at the end of the consultation, blinded from the GP. The endpoint was reconsultation for the same symptoms within one month. RESULTS: Follow-up data was available for 1006 adults, of whom 182 (18%) reconsulted. Fewer patients who received the leaflet (75/505; 14.9%) returned to the surgery compared with those who did not (107/501; 21.4%; P = 0.007). The same benefit was found for the 723 (72%) adults treated initially with antibiotics; 16% (60/369) in the leaflet group returned compared with 23% (81/354) in the no leaflet group (P = 0.02). CONCLUSION: Informing previously well patients about the natural history of LRTi symptoms is an effective strategy for reducing reconsultations, benefiting the patient and the GP; it is likely to reduce antibiotic prescriptions and future patient consultation habits.
PMCID: PMC1409927  PMID: 9519518
22.  Streptococcus milleri pulmonary disease: a review and clinical description of 25 patients. 
Thorax  1995;50(10):1093-1096.
BACKGROUND--Streptococcus milleri is increasingly being recognised as an important pulmonary pathogen which may lead to the development of empyema or lung abscess. Although several small series have been reported, the clinical and laboratory features have yet to be fully characterised. METHODS--Twenty five cases were identified and the clinical and laboratory data from case records were analysed. RESULTS--There were 16 empyemas, five lung abscesses, and four with both lung abscess and empyema. The mean age of the patients was 61 years (range 36-89) and 84% were men. The most common symptoms at presentation were shortness of breath, chest pain, cough, and weight loss; only 36% had a fever. Four of the nine patients with lung abscess required a diagnostic lobectomy because of suspected malignancy. Predisposing factors were present in 80% of patients and included the following: pneumonia, periodontal disease, excess alcohol intake, previous thoracic surgical procedures, and malignancy. Laboratory features of S milleri infection were leucocytosis, neutrophilia, anaemia, abnormal liver function tests, and hypoalbuminaemia. In the group with empyema five patients had a pneumothorax on initial presentation and pleural loculation occurred in 10 of these patients. The median stay in hospital was 34 days (range 11-88). Six patients died, five of whom had significant underlying illnesses. CONCLUSIONS--Pulmonary infection with S milleri may result in considerable morbidity and mortality, and is characterised by a strong male predominance, non-specific symptoms (often without toxicity), the presence of predisposing factors, pleural loculation, pneumothorax, and a protracted stay in hospital.
PMCID: PMC475024  PMID: 7491559
23.  Prospective case-control study of role of infection in patients who reconsult after initial antibiotic treatment for lower respiratory tract infection in primary care. 
BMJ : British Medical Journal  1997;315(7117):1206-1210.
OBJECTIVE: To assess direct and indirect evidence of active infection which may benefit from further antibiotics in adults who reconsult within 4 weeks of initial antibiotic management of acute lower respiratory tract infection in primary care. DESIGN: Observational study with a nested case-control group. SETTING: Two suburban general practices in Arnold, Nottingham, over 7 winter months. SUBJECTS: 367 adults aged 16 years and over fulfilling a definition of lower respiratory tract infection and treated with antibiotics. 74 (20%) patients who reconsulted within 4 weeks for the same symptoms and 82 "control" patients who did not were investigated in detail at fallow up. MAIN OUTCOME MEASURES: Direct and indirect evidence of active infection at the time of the reconsultation or the follow up visit with the research nurse for the controls. Investigations performed included sputum culture, pneumococcal antigen detection, serial serology for viral and atypical pathogens and C reactive protein, throat swabs for detecting viral and atypical pathogens by culture and polymerase chain reaction, and chest radiographs. RESULTS: Demographic and clinical features of the groups were similar. Two thirds of the 74 patients who reconsulted received another antibiotic because the general practitioner suspected continuing infection. Any evidence of infection warranting antibiotic treatment was uncommon at reconsultation. The findings for the two groups were similar for the occurrence of identified pathogens; chest x ray changes of infection (present in 13%); and C reactive protein concentrations, which had nearly all fallen towards normal. Only three patients in the reconsultation group had concentrations > or = 40 mg/l. Pathogens identified at follow up in the 156 patients in both groups included ampicillin sensitive bacteria in six. Atypical infections diagnosed in 27 (Chlamydia pneumoniae in 22) and viral infections in 54 had probably been present at the initial presentation. CONCLUSION: Our study suggests that active infection, which may benefit from further antibiotics, is uncommon in patients who reconsult after a lower respiratory tract infection, and a repeat antibiotic prescription should be the exception rather than the rule. Other factors, such as patients' perception of their illness, may be more important than disease and infection in their decision to reconsult.
PMCID: PMC2127769  PMID: 9393227
24.  Influence of patients' expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. 
BMJ : British Medical Journal  1997;315(7117):1211-1214.
OBJECTIVE: To assess patients' views and expectations when they consult their general practitioner with acute lower respiratory symptoms and the influence these have on management. DESIGN: General practitioners studied consecutive, previously well adults and recorded clinical data, the certainty regarding their prescribing decision, and the influence of non-clinical factors on that decision. Patients completed a questionnaire at home after the consultation. SETTING: 76 doctors from suburban, inner city, and rural practices. SUBJECTS: 1014 eligible patients entered; 787 (78%) returned the questionnaire. MAIN OUTCOME MEASURES: The views of the patient, the views of and antibiotic prescription by the doctor. RESULTS: Most patients thought that their symptoms were caused by an infection (662) and that antibiotics would help (656) and had both wanted (564) and expected (561) such a prescription. 146 requested an antibiotic, 587 received one. Of the 643 patients who thought they had an infection, 582 wanted an antibiotic and thought it would help. Severity of symptoms did not relate to wanting antibiotics. For those prescribed antibiotics, their doctor thought they were definitely indicated in only 116 cases and not indicated in 126. Patient pressure most commonly influenced the decision to prescribe even when the doctor thought antibiotics were not indicated. Doctors considered antibiotics definitely indicated in only 1% of the group in whom patient pressure influenced the prescribing decision. Patients who did not receive an antibiotic that they wanted were much more likely to express dissatisfaction. Dissatisfied patients reconsulted for the same symptoms twice as often as satisfied patients. CONCLUSION: Patients presenting with acute lower respiratory symptoms often believe that infection is the problem and antibiotics the answer. Patients' expectations have a significant influence on prescribing, even when their doctor judges that antibiotics are not indicated.
PMCID: PMC2127752  PMID: 9393228
25.  Comparison of amoxycillin and clarithromycin as initial treatment of community-acquired lower respiratory tract infections. 
BACKGROUND: Numerous new oral antibiotics have been produced over the last few years with the aims of improving treatment for lower respiratory tract infections. AIM: The aim of the study was to compare the efficacy of an established drug, amoxycillin, with a new macrolide, clarithromycin, for initial treatment of adults with community-acquired lower respiratory tract infection. METHOD: Consecutive adults fulfilling a standard definition of lower respiratory tract infection presenting to 14 general practitioners in two neighbouring practices were allocated to antibiotic therapy in a random, single-blind manner. The outcome of treatment was assessed by the time taken by the patient to return to normal activities or work, the speed of resolution of symptoms, number of repeat consultations and side effects. RESULTS: The profile of the 221 patients receiving amoxycillin was very similar to that of the 221 receiving clarithromycin. The two groups did not differ greatly in requirement to visit the general practitioner again within either 4 weeks (20% amoxycillin group; 25% clarithromycin group) or 3 months (31% compared with 36%) of the original infection, in time taken to return to normal activities (6 days for group taking amoxycillin; 5 days for those on clarithromycin) or work (5 days for both groups), or in speed of resolution of symptoms. Compliance was good and the side-effects reported were similar for both groups. No increase in gastrointestinal complaints was noted for patients taking the macrolide. CONCLUSION: Amoxycillin and clarithromycin appear to be equally effective as initial therapy and to be tolerated in similar ways. Use of the newer drug appears to have no advantages over use of the accepted standard treatment.
PMCID: PMC1239668  PMID: 8983255

Results 1-25 (119)