@article {VerheijBJGP.2021.0344, author = {Theo J Verheij and Daniela Cianci and Alike W van der Velden and Christopher C Butler and Emily Bongard and Samuel Coenen and Annelies Colliers and Nick A Francis and Paul Little and Maciek Godycki-Cwirko and Carl Llor and S{\l}awomir Chlabicz and Christos Lionis and P{\"a}r-Daniel Sundvall and Lars Bjerrum and An De Sutter and Rune Aabenhus and Nicolay Jonassen Harbin and Morten Lindb{\ae}k and Dominik Glinz and Heiner C Bucher and Bernadett Kov{\'a}cs and Bohumil Seifert and Ruta Radzeviciene Jurgute and Pia Touboul Lundgren and Muireann de Paor and Veerle Matheeussen and Herman Goossens and Margareta Ieven}, title = {Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness: a post hoc analysis of randomised controlled trial data}, elocation-id = {BJGP.2021.0344}, year = {2021}, doi = {10.3399/BJGP.2021.0344}, publisher = {Royal College of General Practitioners}, abstract = {Background There is little evidence about the relationship between aetiology, illness severity, and clinical course of respiratory tract infections (RTIs) in primary care. Understanding these associations would aid in the development of effective management strategies for these infections.Aim To investigate whether clinical presentation and illness course differ between RTIs where a viral pathogen was detected and those where a potential bacterial pathogen was found.Design and setting Post hoc analysis of data from a pragmatic randomised trial on the effects of oseltamivir in patients with flu-like illness in primary care (n = 3266) in 15 European countries.Method Patient characteristics and their signs and symptoms of disease were registered at baseline. Nasopharyngeal (adults) or nasal and pharyngeal (children) swabs were taken for polymerase chain reaction analysis. Patients were followed up until 28 days after inclusion. Regression models and Kaplan{\textendash}Meier curves were used to analyse the relationship between aetiology, clinical presentation at baseline, and course of disease including complications.Results Except for a less prominent congested nose (odds ratio [OR] 0.55, 95\% confidence interval [CI] = 0.35 to 0.86) and acute cough (OR 0.42, 95\% CI = 0.27 to 0.65) in patients with flu-like illness in whom a possible bacterial pathogen was isolated, there were no clear clinical differences in presentations between those with a possible bacterial aetiology compared with those with a viral aetiology. Also, course of disease and complications were not related to aetiology.Conclusion Given current available microbiological tests and antimicrobial treatments, and outside pandemics such as COVID-19, microbiological testing in primary care patients with flu-like illness seems to have limited value. A wait-and-see policy in most of these patients with flu-like illness seems the best option.}, issn = {0960-1643}, URL = {https://bjgp.org/content/early/2022/01/24/BJGP.2021.0344}, eprint = {https://bjgp.org/content/early/2022/01/24/BJGP.2021.0344.full.pdf}, journal = {British Journal of General Practice} }