High-Risk Subgroups Have Little, if Any, Net Benefit from Antibiotics for Acute LRTI


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Am Fam Physician. 2015 Oct 1;92(7):640-642.

Clinical Question

Are there subgroups of patients with acute lower respiratory tract infection (LRTI) who do not have clinically suspected pneumonia but who may benefit from antibiotics?

Bottom Line

Patients with acute LRTI and green sputum or cardiopulmonary comorbidities experience a slightly greater benefit with amoxicillin treatment. That outcome must be balanced against the harms of antibiotics on the individual and population level. (Level of Evidence = 1b –)


This is a secondary analysis of data from a large European randomized trial of the treatment of acute LRTI. These researchers recruited 2,061 adults with acute LRTI but no suspected pneumonia. The patients were randomized to receive 1 g of amoxicillin three times daily for seven days or matching placebo. A

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Medical Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


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