Management of adult lower respiratory tract infection in primary care

Acute lower respiratory tract infection (acute bronchitis) refers to the onset of productive cough in a patient with no history of chronic obstructive pulmonary disease and no evidence of pneumonia. The Fourth National Morbidity Survey (1991–2) from general practice claims that acute cough is the most common reason given for consulting a GP in the UK.1 Population based estimates of the incidence of acute bronchitis range from 33 to 45 cases/1000 per year.2 3 Descriptive epidemiology of common symptoms and their natural history and outcome is an area which the MRC highlights as a priority for primary care research.4 In this issue of Thorax Macfarlane et al report a large prospective case series detailing the incidence, aetiology, management, and outcome of previously well adults presenting to their general practitioner with symptoms of acute lower respiratory tract infection.5 They found there was no relationship between the doctor's initial clinical assessment that the patient had an infection warranting antibiotics and the outcome or with subsequent laboratory confirmation of a bacterial/atypical infection. Quantitative systematic reviews of randomised controlled trials of antibiotic prescription for acute …