Mapping the evidence about the natural history of acute infections commonly seen in primary care and managed with antibiotics: a scoping review

Abstract

Abstract Background Knowing the natural history of acute infections in primary care can inform clinicians’ and patients’ expectations about illness recovery, but this evidence is fragmented across the literature. This scoping review aimed to map and describe natural history evidence of acute infections and identify research gaps. Methods We searched MEDLINE, Embase and CENTRAL, using a hierarchical search approach, starting with identifying: i) systematic reviews synthesising natural history data for eligible conditions (acute respiratory, urinary, and skin and soft tissue infections) and ii) systematic reviews of treatment effectiveness (of RCTs with placebo or no treatment arm, or cohort studies), and iii) for conditions without reviews, 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 conditions, 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. We found no eligible studies for cellulitis, ecthyma, carbuncle, and erysipelas. Conclusions Our review has shown that natural history evidence exists for many common 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.