Post by Nadica (She/Her) on Jul 20, 2024 5:46:46 GMT
Nasal sprays, behavioral steps cut sick days, antibiotic use in patients with respiratory illness - Published July 19, 2024
The results of a randomized controlled trial in the United Kingdom suggest that simple, low-cost interventions for respiratory illnesses could have a significant impact on antimicrobial stewardship efforts and the economy, researchers reported last week in The Lancet Respiratory Medicine.
The trial, conducted at 332 UK general practitioner (GP) practices, found that the use of two types of over-the-counter nasal sprays and a digital behavioral intervention reduced antibiotic use by as much as 35% in patients diagnosed as having upper respiratory tract infections. The nasal sprays, when used at the first sign of infection, also reduced illness duration and the number of workdays lost compared with usual care.
Although respiratory tract infections are frequently caused by viruses, they are a significant driver of unnecessary antibiotic prescribing, since GPs don't have a quick way to distinguish viral from bacterial infections and often feel pressure to prescribe antibiotics.
"Most people who attend a general practitioner (GP) practice for respiratory illness are prescribed antibiotics, and antibiotic use in primary care is strongly associated with antibiotic resistance," the study authors wrote. "Effective, low-cost, non-prescription interventions are needed to reduce symptom burden and antibiotic use."
Reduced antibiotic use, shorter illnesses
The open-label, parallel-group Immune Defence trial, led by researchers at the University of Southampton, recruited 13,799 adults who had at least one comorbidity or risk factor that increased their risk of adverse outcomes due to respiratory illness from December 12, 2020, to April 7, 2023. The participants were randomized to four intervention groups on a 1:1:1:1 basis—usual care, gel-based nasal spray, saline nasal spray, or a behavioral website promoting physical activity and stress management—and instructed to use the interventions at the first sign of symptoms or when they came into close contact with someone with a respiratory tract infection.
The primary outcome was the total number of days of illness due to self-reported respiratory-tract illnesses since randomization, reported at a 6-month survey. Key secondary outcomes included days when work or normal activities were impaired, reported incidence of respiratory tract illness, possible adverse events, and use of antibiotics. Neither investigators nor medical staff were aware of treatment allocation.
A total of 11,612 participants had complete data for the primary outcome and were included in the final analysis (3,451 assigned to the usual-care group, 3,448 to gel-based nasal spray, 3,450 to saline nasal spray, and 3,450 to the digital intervention). Compared with the participants in the usual-care group, who had a mean of 8.2 days of illness, participants who received gel-based nasal spray (mean 6.5 days of illness; adjusted incidence ratio [IRR], 0.82; 99% confidence interval [CI], 0.76 to 0.90) and saline spray (mean, 6.4 days; IRR, 0.81; 99% CI, 0.74 to 0.88) had significantly fewer days of illness. The group allocated to the behavioral website did not see a significant reduction in days of illness (mean, 7.4 days; IRR, 0.97; 99% CI, 0.89 to 1.06).
Effective, low-cost, non-prescription interventions are needed to reduce symptom burden and antibiotic use.
In addition, the number of lost workdays or lost days of normal activity was lower in the gel-based spray group (IRR, 0.81; 95% CI, 0.67 to 0.98) and the saline spray group (IRR, 0.72; 95% CI, 0.59 to 0.87) than in the usual care group.
Antibiotic use was lower for all three interventions than with usual care, with an IRR of 0.65 (95% CI, 0.50 to 0.84) for the gel-based spray group, 0.69 (95% CI, 0.45 to 0,88) for the saline spray group, and 0.74 (95% CI, 0.57 to 0.94) for the behavioral website group.
Of those with available data, the most common adverse effect was headache or sinus pain, which was experienced by 4.8% of participants in the usual-care group, 7.8% in the gel-based spray group (risk ratio [RR], 1.61; 95% CI, 1.30 to 1.99), 4.5% in the saline spray group (RR, 0.81; 0.63 to 1.05), and 4.5% in the behavioral website group (RR, 0.95; 95% CI, 0.74 to 1.22).
The study authors also note that the behavioral website was the only intervention to reduce illness incidence, but only slightly (adjusted RR, 0.95; 95% CI, 0.91 to 0.99).
"Although the impact was modest, no support is required for this intervention, which could be potentially important at the population level," they wrote.
Simple measures
The authors add that while the reduction in antibiotic use and workdays lost was small in terms of absolute benefit, if all three interventions were implemented more broadly, the impact could be significant.
"If widely advocated and implemented, these simple scalable interventions could potentially have an important impact on antimicrobial stewardship, and in reducing the impact of respiratory viruses for patients, the health service, and the wider economy," they wrote.
In an accompanying commentary, infectious disease specialist Evangelos Giamarellos-Bourboulis, MD, PhD, of National and Kapodistrian University of Athens, says the findings are important because the interventions are simple, they limit the unfavorable outcomes from respiratory tract infections, and they enable clinicians to provide proactive treatment while avoiding unnecessary antibiotics.
"To tackle the issue of antimicrobial resistance, the amount of antibiotics prescribed will need to be reduced," he wrote. "Little and colleagues show how such reductions could be achieved through simple measures, and they should be congratulated for their effort."
The results of a randomized controlled trial in the United Kingdom suggest that simple, low-cost interventions for respiratory illnesses could have a significant impact on antimicrobial stewardship efforts and the economy, researchers reported last week in The Lancet Respiratory Medicine.
The trial, conducted at 332 UK general practitioner (GP) practices, found that the use of two types of over-the-counter nasal sprays and a digital behavioral intervention reduced antibiotic use by as much as 35% in patients diagnosed as having upper respiratory tract infections. The nasal sprays, when used at the first sign of infection, also reduced illness duration and the number of workdays lost compared with usual care.
Although respiratory tract infections are frequently caused by viruses, they are a significant driver of unnecessary antibiotic prescribing, since GPs don't have a quick way to distinguish viral from bacterial infections and often feel pressure to prescribe antibiotics.
"Most people who attend a general practitioner (GP) practice for respiratory illness are prescribed antibiotics, and antibiotic use in primary care is strongly associated with antibiotic resistance," the study authors wrote. "Effective, low-cost, non-prescription interventions are needed to reduce symptom burden and antibiotic use."
Reduced antibiotic use, shorter illnesses
The open-label, parallel-group Immune Defence trial, led by researchers at the University of Southampton, recruited 13,799 adults who had at least one comorbidity or risk factor that increased their risk of adverse outcomes due to respiratory illness from December 12, 2020, to April 7, 2023. The participants were randomized to four intervention groups on a 1:1:1:1 basis—usual care, gel-based nasal spray, saline nasal spray, or a behavioral website promoting physical activity and stress management—and instructed to use the interventions at the first sign of symptoms or when they came into close contact with someone with a respiratory tract infection.
The primary outcome was the total number of days of illness due to self-reported respiratory-tract illnesses since randomization, reported at a 6-month survey. Key secondary outcomes included days when work or normal activities were impaired, reported incidence of respiratory tract illness, possible adverse events, and use of antibiotics. Neither investigators nor medical staff were aware of treatment allocation.
A total of 11,612 participants had complete data for the primary outcome and were included in the final analysis (3,451 assigned to the usual-care group, 3,448 to gel-based nasal spray, 3,450 to saline nasal spray, and 3,450 to the digital intervention). Compared with the participants in the usual-care group, who had a mean of 8.2 days of illness, participants who received gel-based nasal spray (mean 6.5 days of illness; adjusted incidence ratio [IRR], 0.82; 99% confidence interval [CI], 0.76 to 0.90) and saline spray (mean, 6.4 days; IRR, 0.81; 99% CI, 0.74 to 0.88) had significantly fewer days of illness. The group allocated to the behavioral website did not see a significant reduction in days of illness (mean, 7.4 days; IRR, 0.97; 99% CI, 0.89 to 1.06).
Effective, low-cost, non-prescription interventions are needed to reduce symptom burden and antibiotic use.
In addition, the number of lost workdays or lost days of normal activity was lower in the gel-based spray group (IRR, 0.81; 95% CI, 0.67 to 0.98) and the saline spray group (IRR, 0.72; 95% CI, 0.59 to 0.87) than in the usual care group.
Antibiotic use was lower for all three interventions than with usual care, with an IRR of 0.65 (95% CI, 0.50 to 0.84) for the gel-based spray group, 0.69 (95% CI, 0.45 to 0,88) for the saline spray group, and 0.74 (95% CI, 0.57 to 0.94) for the behavioral website group.
Of those with available data, the most common adverse effect was headache or sinus pain, which was experienced by 4.8% of participants in the usual-care group, 7.8% in the gel-based spray group (risk ratio [RR], 1.61; 95% CI, 1.30 to 1.99), 4.5% in the saline spray group (RR, 0.81; 0.63 to 1.05), and 4.5% in the behavioral website group (RR, 0.95; 95% CI, 0.74 to 1.22).
The study authors also note that the behavioral website was the only intervention to reduce illness incidence, but only slightly (adjusted RR, 0.95; 95% CI, 0.91 to 0.99).
"Although the impact was modest, no support is required for this intervention, which could be potentially important at the population level," they wrote.
Simple measures
The authors add that while the reduction in antibiotic use and workdays lost was small in terms of absolute benefit, if all three interventions were implemented more broadly, the impact could be significant.
"If widely advocated and implemented, these simple scalable interventions could potentially have an important impact on antimicrobial stewardship, and in reducing the impact of respiratory viruses for patients, the health service, and the wider economy," they wrote.
In an accompanying commentary, infectious disease specialist Evangelos Giamarellos-Bourboulis, MD, PhD, of National and Kapodistrian University of Athens, says the findings are important because the interventions are simple, they limit the unfavorable outcomes from respiratory tract infections, and they enable clinicians to provide proactive treatment while avoiding unnecessary antibiotics.
"To tackle the issue of antimicrobial resistance, the amount of antibiotics prescribed will need to be reduced," he wrote. "Little and colleagues show how such reductions could be achieved through simple measures, and they should be congratulated for their effort."