Project overview
Background Cough is the most common reason for people to see a healthcare professional and often affects older adults. 'Chest infections' are also known as Lower Respiratory Tract Infections (LRTIs). Pneumonia is a serious lung infection that is usually treated with antibiotics. However, most chest infections are not pneumonia, are caused by viruses, and do not respond to antibiotics. A typical GP surgery in the UK will see 4 patients each week aged 65 and over with a chest infection that is not pneumonia (uncomplicated LRTI). Most adults aged over 65 with uncomplicated LRTI currently receive antibiotics. Current guidelines advise against antibiotics for most patients with LRTI but that antibiotics should be considered in older people with other risk factors. This is because older people with other medical conditions are at greater risk of severe illness. However, there is very little evidence on whether antibiotics benefit this group of patients. In a recent survey, GPs rated 'infections in the elderly' as the top priority for all infection research and felt they require more evidence to guide their practice. Use of antibiotics causes antibiotic resistance, where antibiotics no longer work well for infections. Antibiotic resistance is increasing and is a big public health threat, leading to serious infections becoming untreatable. Antibiotic overuse also causes preventable and serious side effects. In another recent survey, most older adults were cautious about antibiotic use, side effects and that overuse can lead to antibiotics not working the next time they are needed. On the other hand, under-prescribing antibiotics may put older adults at risk of longer and more serious infections. Therefore, we want to conduct a study to make sure that patients who do not take antibiotics are no worse in terms of the time it takes them to recove from their illness. This will support clinicians in their daily practice. Aim To find out if recovery from illness (time until all symptoms are gone or rated as a minor problem) is no worse in those who take placebo (inactive treatment) compared with those who take antibiotics. This will be in adults aged 65 and over who are seen in primary care with a 'chest infection' that is not pneumonia. Design Participants aged 65 and over with uncomplicated LRTI will be randomly grouped (like tossing a coin) to have either an antibiotic (doxycycline) or a placebo (inactive but similar looking tablet) for 5 days. Participants will be asked to record their symptoms daily for up to four weeks and we will compare recovery in the two groups. We will also collect a small amount of blood from the fingertip to find out if this can help find out who will benefit from antibiotics. PPI Four public contributors with lived experience or experience of caring for someone with LRTI or pneumonia have helped design this study. Two are members of our study team and will be involved in all further aspects of the study. Dissemination In addition to publishing our findings in well-respected medical journals, we will work with patient groups, clinicians, and the NHS to ensure that the findings are put into practice.
