[Lower respiratory tract infections unravelled]

Global initiatives to tackle the rise of antimicrobial resistance highlight the need to invest in the development and use of new, rapid diagnostic tools in routine patient care to differentiate bacterial from viral infections. Selective use may enhance antibiotic stewardship, but should be based on evidence for the target populations. The landmark study of Ieven et al. in 11 European countries describes the role of bacteria, viruses and mixed bacterial-viral infections in adults presenting with mostly non-severe lower respiratory tract infections in primary care. Viruses, particularly rhinoviruses, were much more frequent than bacterial pathogens. The authors conclude that their new findings support a restrictive approach to antibiotic prescribing. Better diagnostics for aetiology are advocated for use in primary care. This article discusses the impact of these new data on the already broadly shared views on antibiotic stewardship, including restrictive use of antibiotics in non-severe infections. The question is raised whether the possible benefits of broad implementation of specific, diagnostic tests for aetiology outweigh the possible harm in primary care. Proper consultation skills are key for differentiating one patient with a severe infection from the many non-severe infections. Treating patients, not diagnoses prevails.