TOPLINE:

Focused lung ultrasound did not achieve the anticipated reduction in antibiotic prescriptions during initial consultations in general practice among adults with acute cough and symptoms of lower respiratory tract infection compared with usual care. However, it significantly decreased reconsultations for lower respiratory tract infections.

METHODOLOGY:

• A pragmatic randomized superiority trial was conducted in Denmark and involved 390 patients with acute lower respiratory tract infections (median age, 58 years; 54% women) and 34 general practitioners across 28 clinics.
• Adults aged 18 years or older with acute cough and symptoms of lower respiratory tract infection and thought to have bacterial pneumonia were included and randomly assigned to receive either usual care (n = 198) or usual care supplemented with focused lung ultrasound (n = 192); 99% underwent C-reactive protein point-of-care testing.
• Family medicine specialists who worked as general practitioners and used ultrasound weekly in practice or during out-of-hours care were eligible to enroll patients.
• Patients completed a 21-day symptom diary via message service, covering dimensions such as cough, dyspnoea, and general well-being and questions regarding cancellation of work-related and leisure activities.
• The primary outcome was the proportion of patients prescribed antibiotics at the index consultation, and secondary outcomes included reconsultations and hospital admissions.

TAKEAWAY:

• Overall, 36% of patients in the focused lung ultrasound group were prescribed antibiotics compared with 41% in the usual care group. No significant reduction in the risk for antibiotic prescriptions was observed with the addition of focused lung ultrasound.
• Within 28 days of the index consultation, the risk for reconsultation for lower respiratory tract infections in general practice or out-of-hours primary care was significantly lower in the focused lung ultrasound group (relative risk, 0.76; P = .038).
• Patient satisfaction was high in both groups, with 91% reporting satisfaction or high satisfaction with the consultation, and no unintended events were reported within 60 days.
• Antibiotics were prescribed to 65% of patients with pathologic findings on focused lung ultrasound vs 13% of those without such findings.

IN PRACTICE:

"FLUS [focused lung ultrasound] is not recommended as a routine tool for all adults with suspected pneumonia based on this trial's findings. However, the study found no evidence of patient harm associated with the addition of FLUS to usual care," the authors wrote.

SOURCE:

The study was led by Julie Jepsen Strøm, of the Center for General Practice at Aalborg University in Aalborg, Denmark. It was published online on September 18, 2025, in eClinical Medicine.

LIMITATIONS:

The self-selection of participating general practitioners may limit generalizability. The low baseline antibiotic prescribing rates and high uptake of C-reactive protein testing may limit the applicability of the findings. Data on symptom duration prior to the index consultation were lacking.

DISCLOSURES:

The study was funded by The Health Foundation, The Foundation for General Practice, The Lung Association's Research Fund, and regional committees for quality and education. One author reported coauthoring e-learning material and receiving royalties for the same. Some authors reported receiving honoraria from several pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.