A new study published in the European Respiratory Journal, revealed that general physicians (GPs) could differentiate mild and severe pneumonia infection by four objective measures including screening of fever, high heart rate, wheezing and low oxygen levels. Implementation of these measures could help the patients get the treatment early and reduce the unnecessary antibiotic prescriptions.
Pneumonia is a severe lung infection that can be life-threatening and often requires treatment with antibiotics. However, it is extremely difficult to distinguish common viral infection and antibiotic-resistant infection. About one in 20 patients would have pneumonia.
“GPs fail to spot two out of every three cases of pneumonia, although those which are missed are the milder ones with less distinctive features. One of the reasons GPs offer antibiotics is that they are rightly concerned about missing a serious illness," said Michael Moore, Professor of Primary Care Research at the University of Southampton.
The researchers tracked 28,883 patients with lung infections and analyzed the data on their symptoms, test results and treatment details. A total of 720 patients in the study had a chest x-ray and of those, 115 were found to have pneumonia. Some signs and symptoms were found to be common in patients diagnosed with pneumonia.
The temperature higher than 37.8°C, a crackly breath sound, a pulse rate of more than 100 beats/minute, and oxygen saturation in the blood lower than 95%. They found that 86.1% of patients with pneumonia exhibited at least one of these signs. Moore said that the current study is the first to investigate whether oxygen saturation could indicate pneumonia and the results do support using pulse oximetry in assessing patients in primary care.
“We cannot rule out that widespread use might result in more patients being referred to hospital. For this reason, it should be considered by GPs in conjunction with a clinical examination and other factors.” “The rise in drug-resistant infections is an international priority and one of the contributors to antibiotic resistance is unnecessary prescribing,” said Moore.
Identification of those patients with low risk of complications and prescribing antibiotics to those who had one or more those signs could lead to the reduction in unnecessary prescriptions. Further studies are required to analyze those types of respiratory infections and to test whether the study results could be used in routine general practice in order to optimize diagnosis and prescribe antibiotic only if required.