{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:04:25Z","timestamp":1780445065064,"version":"3.54.1"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":43,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100032581","name":"KLINBEFORSK","doi-asserted-by":"crossref","award":["2023211"],"award-info":[{"award-number":["2023211"]}],"id":[{"id":"10.13039\/100032581","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100012446","name":"Akershus University Hospital","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012446","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Trials"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Reducing inappropriate use of antibiotics is essential to combat antimicrobial resistance. Antibiotics are widely prescribed upon hospital admission for acute respiratory infections, but it remains unknown whether it is safe to discontinue antibiotics when a respiratory virus is detected in these patients. With this randomized trial, we aim to assess the efficacy and safety of discontinuing antibiotic therapy in patients admitted to the hospital with a polymerase chain reaction test positive for respiratory virus and no clear evidence of bacterial infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>ATHENIAN is an ongoing multicenter, open-label, pragmatic, randomized non-inferiority trial. We aim to recruit 400 adult patients initiated on antibiotic therapy at admittance to one of the 10 study sites in Norway and with a positive polymerase chain reaction test for influenza virus, human metapneumovirus, respiratory syncytial virus, or parainfluenza virus. The participants are randomized to intervention, discontinuation of antibiotic therapy, or control, continuation of antibiotic therapy at the discretion of the treating physician. We hypothesize that discontinuation of antibiotic therapy is safe and non-inferior to continuation of antibiotic therapy. The primary outcome, assessed at 120\u00a0h after randomization, is early clinical response, defined as survival with symptom improvement without receipt of rescue antibacterial therapy. Secondary outcomes include all-cause in-hospital and 30-day mortality, duration of hospital admission, days of therapy with antibiotics, rescue antibiotic therapy during hospital admission, new antibiotic therapy for presumed airway infection up to 30\u00a0days after hospital discharge, and hospital readmissions within 30 days after hospital discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>To our knowledge, ATHENIAN is the first randomized controlled trial assessing the safety and efficacy of antimicrobial de-escalation based on multiplex nucleic acid amplification test results. Addressing this knowledge gap using a pragmatic study design will provide valuable insights that may influence treatment algorithms and antibiotic prescription practices. The study has the potential to contribute to a reduction in the inappropriate use of antibiotics and the emergence of antimicrobial resistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT05045612. Registered on September 7, 2021.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13063-026-09730-3","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T07:54:51Z","timestamp":1776758091000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic therapy in viral airway infections (ATHENIAN): study protocol for an open labeled randomized controlled pragmatic trial to evaluate the efficacy and safety of discontinuing antibiotic therapy in adult patients infected with respiratory viruses"],"prefix":"10.1186","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0654-6897","authenticated-orcid":false,"given":"Magrit Jarlsdatter","family":"Hovind","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Erik","family":"Berdal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u016brat\u0117 \u0160altyt\u0117","family":"Benth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olav","family":"Dalgard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus Nakrem","family":"Lyngbakken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"9730_CR1","unstructured":"WHO. 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The Norwegian Medical Products Agency approved the study 14 October 2021 (EudraCT#2021\u2013004248-11\/EU CT#2023\u2013509286-20-00) and the change to multicenter on 3 August 2023. Additionally, the study was approved by the local data protection officer at each study site. Written informed consent is obtained from all participants before enrollment.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate {30}"}},{"value":"Not applicable as this manuscript does not contain any identifying details or photos of participants.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests {7b}"}}],"article-number":"410"}}