Researchers from the University of Southampton in the United Kingdom recently published results in The Lancet Respiratory Medicine journal from the Immune Defence trial. The study involved 13,799 adults at risk of adverse respiratory illness outcomes.
Conducted at 332 general practitioner practices, the participants were randomized to four intervention groups on a 1:1:1:1 basis—usual care, gel-based nasal spray, saline nasal spray, or a behavioral website promoting physical activity and stress management—and instructed to use the interventions at the first sign of symptoms or when they came into close contact with someone with a respiratory tract infection.
The primary outcome measured was the total number of illness days due to respiratory-tract illnesses over six months. Key secondary outcomes included days when work or normal activities were impaired, reported incidence of respiratory tract illness, possible adverse events, and use of antibiotics.
Key Study Findings:
- Gel-based and saline nasal sprays reduced illness duration to about 6.5 and 6.4 days, respectively, compared to 8.2 days with usual care.
- The digital behavioral intervention did not significantly reduce illness duration, but slightly reduced illness incidence.
- All interventions led to lower antibiotic use by up to 35% and fewer lost workdays.
- The most common adverse effect was headache or sinus pain, particularly in the gel-based spray group.
“Although respiratory tract infections are often caused by viruses, they are a significant driver of unnecessary antibiotic prescribing. Providers lack a fast, cost-effective way to distinguish viral from bacterial infections and they often feel pressured by patients to prescribe antibiotics. The study highlights the potential for these interventions to impact antimicrobial stewardship by reducing antibiotic resistance, adverse effects, such as C. difficile, and health care costs,” explained Carrie Sorenson, PharmD, Great Plains QIN Quality Improvement Advisor.
Tools, Resources, Training
- Connecting the Dots – Antibiotic Stewardship, Immunization, Sepsis
- Antimicrobial Stewardship | Agency for Healthcare Research and Quality
- Antibiotic Prescribing and Use
- CDC Symptom Relief for Viral Illnesses
- Core Elements of Antibiotic Stewardship | Antibiotic Prescribing and Use | CDC
- Antibiotic Resistance and Antimicrobial Stewardship | Health and Human Services North Dakota
References: Nasal sprays, behavioral steps cut sick days, antibiotic use in patients with respiratory illness | CIDRAP (umn.edu)
Little, P., Vennik, J., and Rumsby, et al. (2024). Nasal sprays and behavioural interventions compared with usual care for acute respiratory illness in primary care: A randomised, controlled, open-label, parallel-group trial. The Lancet Respiratory Medicine, 12(8), 619-632. https://doi.org/10.1016/S2213-2600(24)00140-1
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