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Spiegel op de huisarts: over registratie van ziekte, medicatie en verwijzingen in de geautimatiseerde huisartsenpraktijk. Groningen, the Netherlands: Disciplinegroep Huisartsgeneeskunde, University of Groningen; 1998: 1-181. Het voorschrijven van geneesmiddelen in de huisartspraktijk. Marrie TJ, Peeling RW, Fine MJ, Singer DE, Coley CM, Kapoor WN. Ambulatory patients with community-acquired pneumonia: the frequency of atypical agents and clinical course. Berntsson E, Lagergard T, Strannegard O, Trollfors B. Etiology of community-acquired pneumonia in out-patients. Aetiology of community-acquired pneumonia: a prospective study among adults requiring admission to hospital. New and emerging etiologies for community-acquired pneumonia with implications for therapy. Woodhead MA, Macfarlane JT, McCracken JS, Rose DH, Finch RG. Prospective study of the aetiology and outcome of pneumonia in the community. Jonsson JS, Sigurdsson JA, Kristinsson KG, Guthnadottir M, Magnusson S. How close do we come to its aetiology in general practice? Macfarlane JT, Colville A, Guion A, Macfarlane RM, Rose DH. Prospective study of aetiology and outcome of adult lower-respiratory-tract infections in the community. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. Antimicrobial treatment of community acquired pneumonia in adults: a conference report. Comparative study of clarithromycin and roxithromycin in the treatment of community-acquired pneumonia. A randomized double-blind controlled trial of roxithromycin and cefaclor in the treatment of acute lower respiratory tract infections in general practice. Evaluation of roxithromycin (RU-965) versus cephradine in pneumococcal pneumonia. Three-day azithromycin compared with ten-day roxithromycin treatment of atypical pneumonia. A review of its antibacterial activity, pharmacokinetic properties and clinical efficacy. Cramer JA, Mattson RH, Prevey ML, Scheyer RD, Ouellette VL. Randomized controlled trials in primary care: case study. Aetiology, outcome and prognostic factors in community-acquired pneumonia requiring hospitalization. Ortqvist A, Valtonen M, Cars O, Wahl M, Saikku P, Jean C. Oral empiric treatment of community-acquired pneumonia. A multicenter, double-blind, randomized study comparing sparfloxacin with roxithromycin. Acute bronchitis in the community: clinical features, infective factors, changes in pulmonary function and bronchial reactivity to histamine. Trigg CJ, Wilks M, Herdman MJ, Clague JE, Tabaqchali S, Davies RJ. A double-blind comparison of the effects of cefaclor and amoxycillin on respiratory tract and oropharyngeal flora and clinical response in acute exacerbations of bronchitis. Roxithromycin 150 mg bid versus amoxicillin 500 mg/clavulanic acid 125 mg tid for the treatment of lower respiratory tract infections in general practice. Antibioticagebruik en het optreden van resistentie. National Institute of Public Health and the Environment/Volksgezondheid Toekomst Verkenning 1997;B3:793-800. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Effectiveness of erythromycin in the treatment of acute bronchitis. Treatment of community-acquired pneumonia: a randomized comparison of sparfloxacin, amoxycillin-clavulanic acid and erythromycin. Partial compliance in cardiovascular disease: risk implications. Effect of microelectronic observation on compliance. Favre O, Delacretaz E, Badan M, Glauser M, Waeber B. Relationship between the prescriber’s instructions and compliance with antibiotherapy in outpatients treated for an acute infectious disease. Role of patient compliance in clinical pharmacokinetics. OBJECTIVE: To assess the efficacy of roxithromycin relative to amoxicillin. STUDY DESIGN: We conducted a double-blind randomized controlled trial of oral 500 mg amoxicillin 3 times per day vs oral 300 mg roxithromycin once a day for 10 days. POPULATION: We included 196 adults who had presented to a general practitioner with lower respiratory tract infection (LRTI) and, in the physician’s opinion, needed antibiotic treatment. OUTCOMES MEASURED: We measured clinical response after 10 and 28 days, defined in 4 ways: (1) decrease in LRTI symptoms; (2) complete absence of symptoms; (3) decrease in signs; and (4) complete absence of signs. Self-reported response included the decrease in symptoms and the time until resumption of impaired or abandoned daily activities on days 1 through 10, 21, and 27. RESULTS: Clinical cure rates after the completion of antibiotic treatment (10 days) were not significantly different for the 2 groups. After 28 days, the roxithromycin group showed no increase in cure rate as evidenced by the decrease in symptoms, indicating a significantly lower cure rate. However, this difference did not alter physicians’ overall conclusion after complete follow-up that 90% of patients, regardless of age, had been effectively treated with either amoxicillin or roxithromycin. CONCLUSIONS: The surplus value of roxithromycin was not confirmed. Amoxicillin remains a reliable first-choice antibiotic in the treatment of LRTI in general practice. Acute community-acquired lower respiratory tract infections (LRTIs) in adults include acute bronchitis, pneumonia, and infectious episodes in patients with asthma or chronic obstructive pulmonary disease (COPD). In acute bronchitis and exacerbations of COPD, the value of antibiotic therapy is doubtful; in pneumonia, however, it is widely accepted. Because distinguishing between these disease entities on clinical grounds alone is often impossible, deciding which patients would benefit from antibiotic treatment remains difficult. 1-6 In the Netherlands, as in the United States and Great Britain, antibiotics are prescribed for patients with acute bronchitis approximately 80% of the time. If a primary care physician (PCP) decides to treat LRTI with antibiotics, amoxicillin is the drug of first choice in the Netherlands.
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