The edition · Family Medicine
Bacteria on a nasal swab did not predict a slower recovery from chest infection
A Swiss primary care analysis found PCR-detected bacteria made no difference to how fast lower respiratory infections settled, with or without antibiotics. Also: new-onset diabetes as a pancreatic cancer signal, the 'interim' diagnoses that precede cancer, and influenza before the season.
The edition in brief
Today's family medicine edition closes on a BJGP secondary analysis of a Swiss primary care trial: among 345 adults with lower respiratory tract infection, 41% had bacteria detected by PCR on a nasopharyngeal swab, yet median recovery was seven days in both groups (adjusted hazard ratio 1.13, 95% CI 0.84 to 1.50), and antibiotics did not change that. Cough lasted a median of 16 days. An English validation of the ENDPAC score in 70,050 adults over 50 with new-onset diabetes gave an area under the curve of 0.73; a score of 3 or more flagged 28% of patients and caught 63% of later pancreatic cancers, with a positive predictive value of 0.6%. An English case-control study of 223,422 patients identified 37 non-cancer 'interim' diagnoses, such as reflux or gastritis, that preceded cancer and were linked to its stage and survival. A family practice review of influenza summarises vaccination, testing and antiviral use: antivirals shorten symptoms by about 20 hours when started early, with little evidence of fewer complications. The pearl covers how long acute cough really lasts.
Influenza before the season: who needs antivirals, and what they really achieve
Vaccinate broadly, treat high-risk and severely ill patients early with antivirals, and tell low-risk patients the benefit is about a day of symptoms.
New-onset diabetes after 50: the ENDPAC score as a pancreatic cancer flag
Treat new diabetes after 50 with weight loss as a possible pancreatic cancer signal and ask about red-flag symptoms, rather than imaging everyone.
Reflux, gastritis and other 'interim' diagnoses before cancer: where safety-netting matters
When a benign diagnosis explains a possible cancer symptom, give a clear review plan and revisit the label if symptoms persist.
Acute cough lasts about three weeks, so say so at the first visit
Tell patients with acute cough to expect about three weeks, and give clear reasons to return sooner.
Chest infection in primary care: bacteria on a nasal PCR swab did not predict recovery
Do not let a positive bacterial PCR on a nasal swab drive antibiotics for chest infection in primary care; decide on clinical grounds.
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