The natural world is replete with bacteria.
Humans have existed on this planet for millennia.
In the ages before antibiotics, many humans succumbed to bacterial infections – while, of course, the vast majority survived.
This is not a profoundly reliable observational study, but it does help reinforce this basic concept. This report is a secondary analysis of the GRACE-10 study, which involved primary care patients recruited with a diagnosis of acute cough. The original study was a randomized, placebo-controlled trial for non-specific lower respiratory tract infection, as part of a genomics analysis for evaluation of antibiotic resistance.
This analysis, however, looks solely at the placebo arm, and examines the symptom course and resolution of those who were ultimately diagnosed with a bacterial cause of their LRTI and compares the with those who were not. Of the 834 patients included in their analysis (those with complete symptom diaries), 162 were thought to have a bacteria pathogen based on respiratory culture, nasal swab, or whole blood antibody titers.
S pneumoniae and H influenzae were the most common bacterial pathogens, with most of the remainder the “atypicals” for community-acquired pneumonia. And, at the end of the day: virtually everyone did fine. Patients with a confirmed bacterial pathogen in the setting of their LRTI improved slightly more slowly than those without, had more re-visits in follow-up due to worsening or new symptoms, and a greater percentage were placed on antibiotics in follow-up (12% vs. 6%). The remainder eradicated their bacterial pathogens without antibiotics – you know, the way humans and other contemporary mammals survived for eons.
Now, some of these cases positive for LRTI may be colonization and not pathogenic infection, while some of the negative cases were not diagnosed due to lack of sensitivity. But, regardless, the overall point of this article is probably valid – some bacterial infections will worsen, but in the generally healthy population, a delayed-antibiotic strategy might be valid as an attempt to improve antibiotic stewardship.
“Disease Course of Lower Respiratory Tract Infection With a Bacterial Cause”