Lower Respiratory Tract Infections Managed in Primary Care in France

Lower Respiratory Tract Infections Managed in Primary Care: A 10-year Nationwide Real-World Data Warehouse Study

Primary aim:

To describe participant characteristics at the time of the index lower respiratory tract infection (LRTI) episode in adults managed in primary care in France, using anonymized electronic health records from routine clinical practice between January 2015 and December 2024.

Secondary aims:

To describe and quantify patterns of antibiotic prescribing (rate, type, and duration of treatment) and short-term outcomes, including LRTI-related reconsultations and severe complications within 30 days after the index consultation.

The overall objective is to better characterize real-world management and outcomes of lower respiratory tract infections in primary care and to identify potential areas for improving quality of care and optimizing antibiotic stewardship.

Study Overview

• Status: Completed
• Conditions: Influenza; Acute Bronchitis; Lower Respiratory Tract Infections; Community Acquired Pneumonia (CAP); Acute Exacerbation Chronic Obstructive Pulmonary Disease

Detailed Description

Lower respiratory tract infections are a frequent reason for consultation and antibiotic prescribing in primary care. However, nationally representative data describing real-world management in routine practice remain limited in France.

This nationwide retrospective observational study uses anonymized electronic health records from the THIN® France database, a large primary care data warehouse collecting routinely recorded clinical data from general practitioners. The study includes adults aged 18 years and older with a recorded episode of community-acquired lower respiratory tract infection between January 2015 and December 2024.

Each participant contributes a single index episode and is followed for 30 days to assess short-term outcomes. The study period allows the evaluation of management practices over a 10-year timeframe in routine ambulatory care.

The main objective is to describe patients characteristics and real-world management of lower respiratory tract infections in primary care, with a focus on patterns of care, treatment strategies, and short-term outcomes. This study is based exclusively on previously collected anonymized data and does not involve any intervention or change in patient care.

By providing a large-scale overview of routine practice, the study aims to improve understanding of current management approaches and identify potential areas for optimizing antibiotic use in primary care.

• Study Type: Observational
• Enrollment (Actual): 230066

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adult patients (≥18 years) with a recorded episode of community-acquired lower respiratory tract infection (LRTI) in French primary care between January 1, 2015 and December 31, 2024, identified from anonymized electronic health records in the THIN France database. Patients were required to have at least 12 months of prior medical history before the index episode.

Description

Inclusion Criteria:

• Age ≥18 years
• Recorded diagnosis of community-acquired lower respiratory tract infection in primary care between Jan 1, 2015 and Dec 31, 2024
• At least 12 months of medical history available before the index consultation

Exclusion Criteria:

• Age <18 years
• Less than 12 months of medical data before index date

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Antibiotic-Treated LRTI; Adults with a recorded community-acquired lower respiratory tract infection (LRTI) in primary care in France between January 2015 and December 2024 whose index episode was associated with an antibiotic prescription during routine care. No intervention was assigned by the study.
Non-Antibiotic-Treated LRTI; Adults with a recorded community-acquired lower respiratory tract infection (LRTI) in primary care in France between January 2015 and December 2024 whose index episode was not associated with an antibiotic prescription during routine care. No intervention was assigned by the study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Participant Characteristics at Index LRTI Episode	Descriptive summary of participant characteristics at the index lower respiratory tract infection episode, including age, sex, body mass index, smoking status, alcohol use, comorbidities, and vaccination status, overall and by antibiotic exposure group.	Index consultation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Antibiotic Prescribing Rate	Proportion of participants with an antibiotic prescription at the index episode, stratified on LRTI type	Index consultation
Type of Antibiotics Prescribed for Antibiotic-treated LRTIs	Distribution of antibiotic classes prescribed at the index episode.	Index consultation
Duration of Antibiotic Treatment for Antiobiotic-treated LRTIs	Duration of antibiotic treatment prescribed for the index episode.	Index consultation
30-Day LRTI-Related Reconsultation Rate	Proportion of participants with a follow-up consultation related to LRTI within 30 days.	30 days
30-Day Severe Complication Rate After LRTI	Occurrence of Sepsis/septic shock, Pleural effusion, Lung abscess, Acute respiratory distress syndrome (ARDS) within 30 days after the index episode.	30 days

Collaborators and Investigators

• Sponsor: Hôpital Raymond Poincaré
• Collaborators: University of Lausanne Hospitals; Versailles Saint-Quentin-en-Yvelines University; Clinityx by Gers Data

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2015
• Primary Completion (Actual): December 31, 2024
• Study Completion (Actual): January 9, 2026

Study Registration Dates

• First Submitted: February 10, 2026
• First Submitted That Met QC Criteria: February 10, 2026
• First Posted (Actual): February 18, 2026

Study Record Updates

• Last Update Posted (Actual): February 18, 2026
• Last Update Submitted That Met QC Criteria: February 10, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Primary Care; Electronic Health Records; Antimicrobial Stewardship
• Additional Relevant MeSH Terms: Respiratory Tract Infections; Infections; Orthomyxoviridae Infections; RNA Virus Infections; Virus Diseases; Respiratory Tract Diseases; Lung Diseases; Bronchial Diseases; Lung Diseases, Obstructive; Pneumonia; Community-Acquired Infections; Influenza, Human; Bronchitis; Community-Acquired Pneumonia
• Other Study ID Numbers: LRTI-20152024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data come from an anonymized database with legal and contractual restrictions.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No