Abstract
Background
Knowing the natural history of acute infections in primary care, defined as the course of a disease over time in the absence of specific therapy or treatment, can inform clinicians’ and patients’ expectations about illness recovery, but this evidence is fragmented across the literature. This scoping review aimed to map existing research and research gaps relevant to the natural history of acute infections.
Methods
We searched MEDLINE, Embase and CENTRAL using a 2-phase hierarchical search approach. In Phase A, we focused on identifying systematic reviews synthesising natural history data for eligible infections (acute respiratory, urinary, and skin and soft tissue) and systematic reviews of treatment effectiveness (of RCTs with placebo or no treatment arm, or cohort studies). For infections without existing reviews, in Phase B, we searched for primary studies (placebo-controlled RCTs or cohort studies). Two reviewers independently screened and extracted the data (study characteristics, outcome data - e.g., symptom duration, proportion with resolution at various time points).
Results
We identified 40 systematic reviews, reporting on 45 infections, most commonly (90%) respiratory tract infections. Six (15%) of these aimed to synthesise natural history information. Most reviews reported the proportion of participants with symptom resolution at various time point/s, with 58% providing data on mean symptom duration. Recovery data show the spontaneous resolution of some infections in some people. We found no eligible studies for cellulitis, ecthyma, carbuncle, and erysipelas.
Conclusions
Our review has shown that natural history evidence exists for many common acute infections. It can be utilised by clinicians in implementing patient-centred antibiotic stewardship strategies in primary care. Future research should focus on generating natural history evidence for skin and soft tissue infections and urinary tract infections.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Background
Antibiotic resistance is a global public health emergency threatening our ability to manage infections [1]. The vast tonnage of antibiotic use is a major driver of resistance, with most overuse in primary care [2,3,4]. Most antibiotics are overused in self-limiting acute infections [5, 6], such as various acute respiratory infections, where antibiotics have a delicate benefit-harm trade-off [7, 8]. Many patients and clinicians believe antibiotics are always necessary for these infections, overestimating their benefits and underestimating harms [9, 10].
Antibiotic stewardship strategies are a public health priority [1]. Strategies that can be implemented individually in primary care include delayed prescribing [11] and shared decision making [12]. Central to these is prescribers knowing and communicating the natural history of common acute infections [13], that is, the course of a disease over time in the absence of specific therapy or treatment [14], which for acute infections is typically antibiotics. Knowledge of the likely duration of an infection may facilitate informed decision-making and decrease patients’ expectations of and requests for antibiotics [13, 15].
Given the importance of natural history knowledge for clinical decision-making and its relevance to primary care antibiotic stewardship strategies, it has been a surprisingly neglected area of research [16]. Evidence about natural history appears to be fragmented across the literature, with no existing databases or repositories of synthesised information, like there is for treatment evidence [16]. Awareness of existing research on self-limiting infections and its gaps can inform future research agendas. This scoping review aims to identify existing research and research gaps relevant to the natural history of acute infections commonly seen in primary care (such as acute respiratory, urinary, and skin and soft tissue infections) and often managed with antibiotics.
Methods
The review followed the PRISMA-ScR checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) [17]. The protocol was registered in the Open Science Framework [18].
Information sources and search strategy
We searched MEDLINE, Embase, and Cochrane CENTRAL databases from inception to February 2022, with no language restriction. We used a hierarchical search approach, starting with Phase A: identifying (i) eligible systematic reviews that had the primary aim of synthesising the natural history of eligible infections and (ii) systematic reviews of studies (randomised controlled trials (RCT) with a placebo or no treatment arm; or prospective cohort studies) that studied the effectiveness of antibiotics or other treatments. In Phase B, we searched for eligible primary studies (prospective cohort studies and RCTs with placebo arm) of infections for which no eligible systematic reviews were identified in Phase A. See Additional Box 1 for the search strategies.
The searches were conducted in MEDLINE using free-text words and MeSH terms. The search string was translated into other database platforms using Polyglot Search Translator with the help of an information specialist (Additional Box 2 for MEDLINE search strategy) [19]. We also screened 120 records identified in a previous systematic review of the reporting of natural history information in clinical practice guidelines [20].
Inclusion and exclusion criteria
Study design eligibility was as described in the above section. We included reviews of patients from primary and ambulatory care settings of any age with any of these infection categories: acute respiratory infection (ARI), uncomplicated urinary tract infection (UTI), skin and soft tissue infection (SSTI) - see Additional Box 3 for eligible illnesses within each category. Primary and ambulatory care settings were defined as care provided to patients at their first encounter with the health system, including general practice, out-of-hour services, outpatient clinics, paediatric clinics, and emergency departments. To be included, studies must have reported outcome data on the duration of symptoms and/or the proportion of participants with symptom resolution at any time point/s.
Selection of sources of evidence and data extraction
Two reviewers independently screened titles and abstracts, then the full text of potentially eligible records. Disagreements were resolved through discussion or third reviewer consultation. Potentially eligible non-English articles were translated using Google Translate.
Two reviewers independently extracted data, including study design, population characteristics, and eligible outcomes, using a custom-designed data extraction form. The form was piloted on five randomly selected reviews.
We extracted the duration of symptoms and/or the proportion of control group participants who experienced symptom resolution or worsening at any time point/s as reported in the included reviews. In reviews where only some of the included trials met this scoping review’s eligibility criteria, we extracted data from only the eligible trials (those with a placebo or no treatment comparison).
Synthesis of results
We calculated descriptive statistics using Microsoft Excel 365® and created an evidence map of eligible reviews for each infection. For each infection, we report the mean or median duration of infection as reported in the reviews and present scatter plots of the proportion of the control group participants who experienced symptom resolution at reported time points.
Results
Phase A: Our database search for systematic reviews identified 16,969 records, of which 4,601 were duplicates. From a systematic review [20] of guidelines’ reporting of natural history information, we added 120 records to screen. We excluded 12,173 records after title and abstract screening and assessed the full text of 315 reviews. We included 40 eligible reviews, reporting 45 infections (two reported multiple infections) [13, 21]. See Fig. 1 for PRISMA flow diagram and Additional Tables 1 and 2 for the included and excluded reviews with reasons.
Phase B: We searched for primary studies for conditions with no eligible reviews identified in Phase A (cellulitis, ecthyma, carbuncles, erysipelas). Of 9614 records, 3505 duplicates were removed, and we screened 6109 titles and abstracts and 112 full texts. No eligible studies were identified. See Additional Table 3 for the list of excluded studies with reasons.
Characteristics of included reviews
Most (90%, n = 36) of the systematic reviews addressed Acute Respiratory Infections (ARIs), with three about Skin and Soft Tissue infections (SSTIs) [22, 23] and one review about Urinary Tract Infections (UTIs) [15]. Additional Table 4 shows the characteristics of the included reviews.
Of the 40 included reviews, six (15%) aimed to synthesise natural history information [13, 15, 21, 24,25,26]. Of these, four included participants from cohort and observational studies as well as those from placebo or no treatment arms [13, 21, 24, 25], and two included multiple ARIs [13, 21]. The remaining 34 reviews were treatment effectiveness reviews of RCTs, with some trials using a placebo or no-treatment group. Half of the reviews (n = 20) were published between 2011 and 2015. Most reviews (70%, n = 28) included adults and children as participants. The number of studies included in the reviews ranged between 1 and 34, with the reviews’ total sample size ranging between 146 and 11,077 participants.
Reviews providing information about the natural history of acute infections
See Additional Table 5 for the natural history data reported in the included reviews. Figure 2 presents the evidence map, grouped by condition, the number of reviews for each condition, and whether the review’s focus was synthesising natural history information.
The condition with the largest reported number of reviews was the common cold (n = 11), of which all but one was treatment effectiveness reviews. The sample size in the included reviews ranged between 146 and 6304 participants.
The condition with the second highest number of reported reviews (n = 9) was acute cough, with three reviews aiming to synthesise the natural history data [13, 24, 25]. The sample size of review participants ranged between 274 and 14,289.
Data about acute sinusitis were reported by four reviews, with sample sizes ranging from 1133 to 3057 participants. Three reviews provided natural history data about sore throat (one with an aim to synthesise natural history information [13]), with sample sizes ranging between 277 and 15,337).
Three reviews reported on acute otitis media data [8, 13, 21]. Three [21, 27, 28] reviews of participants ≤ 18 years of age were of otitis media with effusion, with one of these [21] aiming to synthesise natural history data. Two reviews reported data on the natural history of otitis externa [29, 30] and included participants of any age, with a sample size ranging between 3289 and 3382.
Data on bronchiolitis were reported by two reviews [13, 31]. One review [31] included 30 RCTs of infants ≤ 24 months with bronchiolitis, whereas the other review [13] reported data as part of a review reporting multiple ARI conditions and included 4 studies of bronchiolitis.
There was only one review for each of the following conditions: conjunctivitis [32] (11 RCTs, 3673 participants), rhinitis [33] (natural history data in four of the 34 RCTs, 2045 participants), croup [13] (natural history data in three RCTs, 415 participants), laryngitis [34] (natural history data in three RCTs, 351 participants), and acute exacerbation of COPD [35] (natural history data in eight RCTs, 1722 participants).
Only one review addressed UTIs [15] and focussed on synthesising natural history information for uncomplicated UTIs in women (natural history data from three RCTs, 346 participants). One review of impetigo [26], with a natural history focus, synthesised data from seven RCTs (n = 557). Two reviews [22, 23] reported data about the resolution of abscesses after excision and drainage (4 RCTs, 2405 participants; eight RCTs, 2890 participants).
Natural history information available in the included reviews
Figure 3 summarises the mean duration of each condition as reported in reviews. The mean duration of symptoms was reported in 45 (58%) of the conditions.
Figures 4–16 summarise the proportion of participants in the control group with symptom resolution at various time points.
ARIs
Common cold (n = 11): Seven reviews of placebo-controlled RCTs reported mean duration of the common cold, with a range between 3.2 and 10.3 days. Thompson 2013 [13], the only review with a natural history focus, reported a range of 7 and 15 days (Fig. 3). Five reviews reported data on the proportion of participants with symptom resolution (Fig. 4).
Cough (n = 9): The mean duration of cough was reported by six reviews, ranging from 8.9 to 28 days (Fig. 3). One review reported a median duration of 7 to 11 days [36]. Eight reviews reported the proportion of participants with symptom resolution: two reported that by day 14, up to 73% had symptom resolution. The remainder reported that most participants (> 50%) had symptoms resolved by day 15 (Fig. 5).
Sore throat (n = 3): One review [13] reported a mean duration of 2 to 6.7 days. One review, with only one primary study with eligible data, reported a median duration of 2.3 days [37]. Three reviews provided the proportion of participants with symptom resolution (Fig. 6).
Acute otitis media (n = 3): Only one review [13] reported mean duration, with a range between 0.5 and 9 days (Fig. 3). Three reviews reported the proportion of participants with symptom resolution, with ≥ 50% experiencing resolution by day 3 in all reviews (Fig. 7).
Otitis media with effusion (n = 3): No data on mean duration. Three reviews reported data on the proportion of participants who had symptom resolution at various time points (Fig. 8).
Acute sinusitis (n = 4): Two reviews reported mean duration [38, 39], with a range between 7 and 14 days, and one review [40] reported a median duration of 9.5 days (Fig. 3). Three reviews reported symptom resolution at various time points, with > 50% of participants experiencing symptom resolution by about day 9 in all reviews (Fig. 9).
Conjunctivitis (n = 1): One review [32] reported that 31% of participants had symptoms resolved by day 5 and 42% by day 10 (Fig. 10).
Bronchiolitis (n = 2): Two reviews reported a mean duration estimate of 6.6 days in one and between 2 and 6.7 days in the other (Fig. 3). Two reviews reported the proportion with symptom resolution: 84% by day 7 and 90% by day 21 (Fig. 11).
Croup (n =1 ): One review [13] reported a mean duration of 2 to 3 days (Fig. 3) and that 50% of participants had symptom resolution by day 1 and 80% by day 2.
Laryngitis (n = 1): One review [34] reported the proportion of participants with symptom resolution at day 5, 8, and 28 days (44%, 78%, 76%, respectively), with all data from one study in the review (Fig. 12).
Otitis externa (n = 2): One review [30] reported that 15% of placebo participants experienced symptom resolution by day 7 and 10% by day 10 [29] (Fig. 13).
Acute exacerbation of COPD (n = 1): We extracted outcome data from five eligible primary studies in one review [35]. Two of these primary studies reported mean duration (of 12.8 days [41] and 13.5 days [42]). One study [43] in the review reported that 26% of participants had exacerbation symptoms resolved by day 5; another [44] reported that by day 10 and day 20, 60% and 67% of participants had symptom resolution (Fig. 14).
Rhinitis (n = 1): We extracted data from four eligible primary studies in one review [33]. In one study [45], 17% experienced symptom improvement by week 2; in another study, 51% by week 4 [46]. In another two studies, by week 6, 39% and 49% of placebo participants experienced symptom resolution [47, 48] (Fig. 15).
Skin and soft tissue infections
Abscesses (n = 2): Two reviews reported the resolution of uncomplicated skin abscesses after incision and drainage. One review [23] reported resolution in 85% of participants by day 28. The other review [22] reported the outcome separately for each of the four eligible primary studies, with resolution in 74% of participants by day 7 in two studies and in 69% and 95% by days 10 and 14 in the other two (Fig. 16).
Impetigo (n = 1): One review estimated 7 days as the mean duration of impetigo and reported that 13–74% of placebo participants were better by day 7 [26].
Urinary tract infection (n = 1)
One review [15] reported that 42% of participants experienced symptom resolution by day 9. However, most review data were obtained from one of the included trials.
Discussion
We identified 40 systematic reviews that contained 45 natural history conditions. Nearly all (90%) of the reviews were of ARIs (most for common cold, cough, sore throat, or acute otitis media), with only 4 reporting other infections (three Skin and Soft Tissue (SSTIs), one UTIs). Most existing evidence is contained within treatment effectiveness of systematic reviews of placebo-controlled RCTs and needed to be extracted from the reported placebo group results. Only 6 (15%) reviews aimed to synthesise natural history information. We found no reviews or primary studies with natural history data for some conditions eligible for this review (cellulitis, ecthyma, carbuncles, erysipelas).
A strength of this review is its pragmatic yet comprehensive hierarchical searching approach, which allowed us to identify the best available evidence. The heterogeneity of reported information limited our review’s synthesis of results. We did not attempt to update the evidence and search for newly published primary studies when an eligible systematic review was included, regardless of its year of publication. This may have resulted in the omission of some studies that could have provided additional data.
The over-representation of ARI reviews and the under-representation of UTI and skin and soft tissue infection aligns with the findings of a scoping review of the quantity of randomised placebo-controlled trials of antibiotics, with many more trials conducted in ARIs than other infections [49]. For some conditions, the reported mean duration of illness varied across reviews of the same condition. Likely contributors to the variation include differences in the inclusion criteria of primary studies, the definition of symptom resolution, and the estimated duration of illness before study entry/randomisation. A systematic review of 82 clinical guidelines for acute infections also found some variation in the duration of infections reported, likely due to variations in the body of evidence used in each guideline [20].
Our review provides an up-to-date collation of evidence-based information about the natural history of acute infections commonly seen in primary care. Our findings show that many infections will likely resolve spontaneously, which is important in informing clinical decision-making. While there was variation in the recovery timeframes of some infections across the different reviews, the presented information provides a useful snapshot of the available evidence.
Developers of clinical guidelines for acute conditions are encouraged to include natural history information to facilitate clinicians’ access to it and the ability to incorporate the information into patient discussions as part of antibiotic stewardship strategies such as shared decision making and delayed prescribing. However, this information is missing in about 40% of guidelines [20], and sometimes the information provided in guidelines is not evidence-based [50]. In a recent qualitative study with Australian general practitioners, they identified the value of knowing natural history evidence and using it in consultations, but felt ill-prepared to do so without ready access to it [51]. A study of United Kingdom primary care patients found that natural history information is highly desired, but is the most common unmet need in a consultation [52]. Helping patients understand how long common infections are likely to last and their self-resolving nature may help reduce consultation rates for similar infections. While reporting complication data was not within the review’s scope, complications were uncommon in placebo group participants. As there can be a delicate balance between adverse events from treatment and complications from not treating, advice on the waiting period and what to monitor during a “wait-and-see” period should be informed by evidence when it exists.
This scoping review has highlighted the evidence gaps for the natural history of UTIs and SSTIs. More primary studies are needed, followed by systematic reviews to synthesise natural history evidence. Questions surrounding the necessity of antibiotic use for some SSTI and UTI conditions remain because of entrenched beliefs that antibiotics are always needed for managing these infections [53], hindering the conduct of trials with a placebo or no-antibiotic comparator. Future research, such as meta-analyses, which would also appraise studies’ risk of bias, to formally synthesise natural history evidence would be facilitated if authors of primary studies used outcome measures with similar definitions and time points. The variations noted in this review highlights the need to develop core outcome measures for common infections, such as exists for atopic dermatitis [54].
Conclusion
Our review has identified what natural history evidence exists for acute infections commonly managed in primary care and often with antibiotics, even though antibiotics may not always be needed. Most existing evidence is for acute respiratory infections, with identified evidence gaps for the natural history of UTIs and numerous SSTIs. Awareness of existing evidence may facilitate its incorporation into clinical practice guidelines and other decision-support tools and, ultimately, its use in antibiotic stewardship strategies such as delayed prescribing and shared decision making. Additionally, researchers are encouraged to conduct research into the natural history of acute infections where little or no evidence exists.
Data availability
All data generated and analysed during this study are included in this published article [and its Additional Files].
Abbreviations
- RCT:
-
Randomised Controlled Trials
- PRISMA-ScR:
-
Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews
- ARI:
-
Acute Respiratory Infection
- UTI:
-
Uncomplicated urinary Tract Infection
- SSTI:
-
Skin and Soft Tissue Infection
- COPD:
-
Chronic Obstructive Pulmonary Diseases
References
World Health Organisation. Global action plan on antimicrobial resistance. 2015. 2015 [cited 2023 28 Aug]. https://www.who.int/publications/i/item/9789241509763.
Goossens H, Ferech M, Vander Stichele R, Elseviers M, Group EP. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet (London England). 2005;365(9459):579–87.
Lee GC, Reveles KR, Attridge RT, Lawson KA, Mansi IA, Lewis JS, et al. Outpatient antibiotic prescribing in the United States: 2000 to 2010. BMC Med. 2014;12:96.
Ventola CL. The Antibiotic Resistance Crisis. Pharm Ther. 2015;40(4):277–83.
McCullough AR, Pollack AJ, Hansen MP, Glasziou PP, Looke DF, Britt HC, et al. Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations. Med J Aust. 2017;207(2):65–9.
Sulis G, Adam P, Nafade V, Gore G, Daniels B, Daftary A, et al. Antibiotic prescription practices in primary care in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med. 2020;17(6):e1003139.
Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2013(11).
Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2015(6).
Coxeter PD, Mar CD, Hoffmann TC. Parents’ expectations and experiences of Antibiotics for Acute Respiratory infections in Primary Care. Ann Fam Med. 2017;15(2):149–54.
Hoffmann TC, Del Mar C. Clinicians’ expectations of the benefits and Harms of treatments, Screening, and tests: a systematic review. JAMA Intern Med. 2017;177(3):407–19.
Spurling GKP, Del Mar CB, Dooley L, Clark J, Askew DA. Delayed antibiotic prescriptions for respiratory infections. Cochrane Database Syst Rev. 2017(9).
Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database Syst Rev. 2015;2015(11):CD010907.
Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay AD. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ. 2013;347:f7027.
White F. Application of Disease etiology and natural history to Prevention in Primary Health Care: a discourse. Med Princ Pract. 2020;29(6):501–13.
Hoffmann T, Peiris R, Mar CD, Cleo G, Glasziou P. Natural history of uncomplicated urinary tract infection without antibiotics: a systematic review. Br J Gen Pract. 2020;70(699):e714–22.
Glasziou P. The importance of prognostic research. Aust Fam Physician. 2002;31(11):1035.
Tricco A, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Peters MD, Horsley T, Weeks L, Hempel. S PRISMA for Scoping Reviews. 2018.
Boaitey KP, Bakhit M, Hoffmann T. Mapping the evidence about the natural history of acute infections commonly seen in primary care and managed with antibiotics: a scoping review protocol, 2020. https://doi.org/10.17605/OSF.IO/Q9763.
Clark JM, Sanders S, Carter M, Honeyman D, Cleo G, Auld Y, et al. Improving the translation of search strategies using the polyglot search translator: a randomized controlled trial. J Med Libr Assoc. 2020;108(2):195–207.
Boaitey KP, Bakhit M, Krzyzaniak N, Hoffmann TC. Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines. BMC Infect Dis. 2022;22(1):897.
Rosenfeld RM, Kay D. Natural history of untreated otitis media. Laryngoscope. 2003;113(10):1645–57.
Bowen AC, Carapetis JR, Currie BJ, Fowler V Jr., Chambers HF, Tong SYC. Sulfamethoxazole-trimethoprim (cotrimoxazole) for skin and soft tissue infections including Impetigo, Cellulitis, and Abscess. Open Forum Infect Dis. 2017;4(4).
Wang W, Chen W, Liu Y, Siemieniuk RAC, Li L, Martínez JPD, et al. Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis. BMJ Open. 2018;8(2):e020991.
Ebell MH, Lundgren J, Youngpairoj S. How long does a Cough Last? Comparing patients’ expectations with Data from a systematic review of the literature. Annals Family Med. 2013;11(1):5–13.
Hay AD, Wilson AD. The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review. Br J Gen Pract. 2002;52(478):401–9.
Hoffmann TC, Peiris R, Glasziou P, Cleo G, Mar CD. Natural history of non-bullous impetigo: a systematic review of time to resolution or improvement without antibiotic treatment. Br J Gen Pract. 2021;71(704):e237–42.
Griffin G, Flynn CA. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev. 2011(9).
Venekamp RP, Burton MJ, van Dongen TMA, van der Heijden GJ, van Zon A, Schilder AGM. Antibiotics for otitis media with effusion in children. Cochrane Database Syst Rev 2016(6).
Kaushik V, Malik T, Saeed SR. Interventions for acute otitis externa. Cochrane Database Syst Rev. 2010(1).
Rosenfeld RM, Singer M, Wasserman JM, Stinnett SS. Systematic review of topical antimicrobial therapy for acute otitis externa. Otolaryngology–Head Neck Surg. 2006;134(S4):S24–48.
Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2014(6).
Sheikh A, Hurwitz B, van Schayck CP, McLean S, Nurmatov U. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev. 2012(9).
Segboer C, Gevorgyan A, Avdeeva K, Chusakul S, Kanjanaumporn J, Aeumjaturapat S et al. Intranasal corticosteroids for non-allergic rhinitis. Cochrane Database Syst Rev. 2019(11).
Reveiz L, Cardona AF. Antibiotics for acute laryngitis in adults. Cochrane Database Syst Rev. 2015(5).
Vollenweider DJ, Frei A, Steurer-Stey CA, Garcia‐Aymerich J, Puhan MA. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2018(10).
Fahey T, Stocks N, Thomas T. Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults. BMJ. 1998;316(7135):906–10.
de Cassan S, Thompson MJ, Perera R, Glasziou PP, Del Mar CB, Heneghan CJ et al. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev. 2020(5).
Lemiengre MB, Driel MLv, Merenstein D, Liira H, Mäkelä M, Sutter AID. Antibiotics for acute rhinosinusitis in adults. Cochrane Database Syst Rev. 2018(9).
Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ, Del Mar CB, Perera R et al. Systemic corticosteroids for acute sinusitis. Cochrane Database Syst Rev. 2014(3).
Zalmanovici Trestioreanu A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev. 2013(12).
Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987;106(2):196–204.
Fear EC, Edwards G. Antibiotic regimes in chronic bronchitis. Br J Dis Chest. 1962;56:153–62.
Allegra L, Blasi F, de Bernardi B, Cosentini R, Tarsia P. Antibiotic treatment and baseline severity of Disease in Acute exacerbations of Chronic Bronchitis: a re-evaluation of previously published data of a placebo-controlled Randomized Study. Pulm Pharmacol Ther. 2001;14(2):149–55.
Llor C, Moragas A, Hernández S, Bayona C, Miravitlles M. Efficacy of antibiotic therapy for Acute exacerbations of mild to Moderate Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2012;186(8):716–23.
Day JH, Andersson CB, Briscoe MP. Efficacy and safety of intranasal budesonide in the treatment of perennial rhinitis in adults and children. Ann Allergy. 1990;64(5):445–50.
Turkeltaub PC, Norman PS, Johnson JD, Crepea S. Treatment of Seasonal and Perennial Rhinitis with Intranasal Flunisolide. Allergy. 1982;37(5):303–11.
Lundblad L, Sipilä P, Farstad T, Drozdziewicz D. Mometasone furoate nasal spray in the treatment of perennial non-allergic rhinitis: a nordic, multicenter, randomized, double-blind, placebo-controlled study. Acta Otolaryngol. 2001;121(4):505–9.
Schulz JI, Johnson JD, Freedman SO. Double-blind trial comparing flunisolide and placebo for the treatment of perennial rhinitis. Clin Allergy. 1978;8(4):313–20.
Bakhit M, Hoffmann T, Santer M, Ridd M, Francis N, Hummers E et al. Comparing the quantity and quality of randomised placebo-controlled trials of antibiotics for acute respiratory, urinary, and skin and soft tissue infections: a scoping review. BJGP Open 2020;4(4).
The Lancet. Cough guidelines choke on evidence. Lancet. 2006;367(9507):276. https://doi.org/10.1016/S0140-6736(06)68045-8.
Boaitey KP, Hoffmann T, Baillie E, Bakhit M. Exploring general practitioners’ perception of the value of natural history information and their awareness and use of guidelines’ resources to support antibiotic prescribing for self-limiting infections: a qualitative study in Australian general practice. Aust J Prim Health. 2023.
Mallen CD, Peat G. Discussing prognosis with older people with musculoskeletal pain: a cross-sectional study in general practice. BMC Fam Pract. 2009;10(1):50.
Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious diseases. Clin Infect Dis. 2011;52(5):e103–20.
Williams HC, Schmitt J, Thomas KS, Spuls PI, Simpson EL, Apfelbacher CJ, et al. The HOME Core outcome set for clinical trials of atopic dermatitis. J Allergy Clin Immunol. 2022;149(6):1899–911.
Acknowledgements
We gratefully acknowledge the early and valuable discussions about this research project with the late Prof Chris Del Mar. We want to thank Ms Emma Baillie, in her capacity as a research assistant, for her contribution to data screening and extraction and Justin Clark for his contribution and valuable advice in developing the search strategy.
Author information
Authors and Affiliations
Contributions
“KPB, MB and TH conceived the study. KPB developed the search strategy with an information specialist with consultations from MB and TH. KPB and a research assistant assessed study eligibility and extracted data with consultation from MB and TH. KPB analysed the data and created the figures and tables with consultation from MB and TH. KPB is responsible for data management and storage. KPB drafted the manuscript, and all authors reviewed the manuscript and approved the final version for submission”.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Not Applicable.
Consent for publication
Not applicable.
Funding
No specific funding was received for this scoping review. The first author (KPB) is supported with a PhD scholarship, which is funded by the Centre for Research Excellence in Minimising Antibiotic Resistance in the Community (CRE-MARC), funded by the Australian National Health and Medical Research Council (NHMRC) grant [Grant number 1153299]. TH is a chief investigator of CRE-MARC and MB is partly employed as a postdoctoral research fellow on this grant.
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Boaitey, K.P., Bakhit, M. & Hoffmann, T.C. Mapping the evidence about the natural history of acute infections commonly seen in primary care and managed with antibiotics: a scoping review. BMC Infect Dis 24, 721 (2024). https://doi.org/10.1186/s12879-024-09526-3
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12879-024-09526-3