{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T19:20:26Z","timestamp":1771356026183,"version":"3.50.1"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Sapienza University","award":["000317_24"],"award-info":[{"award-number":["000317_24"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Ministries of health need to know and understand factors affecting medical treatment choices of population subgroups, to tailor official recommendations. This study aimed to identify, quantify and compare treatments used by patients with an acute respiratory infection with and without COVID-19 during the first year of the pandemic by accounting for important factors potentially affecting treatment outcomes. With an online questionnaire, retrospective information on treatments used during events of acute respiratory infections were gathered in Italy. Logistic regression was used to detect significant associations between treatments and a set of variables including socio-demographic data, comorbidities and risk factors. We explored differences in treatments used by subjects who developed symptoms of an acute respiratory infection, with and without COVID-19. Women generally took more treatments than men for both, common acute respiratory infections and COVID-19, although, for the latter condition the gender difference in the average number of treatments was smaller. Painkillers (incl. NSAIDs) followed by antibiotics were the most frequently used drugs by both disease groups while the use of macrolide antibiotics and steroids were typical for the COVID group. Logistic regression models for COVID-19 treatments showed significant positive associations between women and the use of food supplements, depression severity and the use of ibuprofen, as well as between both, age class 50\u221264 and cardiovascular pre-conditions with macrolide antibiotics. COVID-19 patients were largely following official recommendations issued by the Italian Ministry of Health, using less complementary and alternative medicines when compared to common acute respiratory infections. Particularly, official recommendations suggesting the use of allegedly anti-inflammatory macrolide antibiotics for COVID-19 seem to have been followed for patients with cardiovascular pre-conditions. Considering that macrolide antibiotics augment the risk for cardiovascular death and that cardiovascular diseases are known to be a risk factor for COVID-19 related death, treating COVID-19 patients with macrolide antibiotics was probably not a great idea.<\/jats:p>","DOI":"10.1371\/journal.pone.0342466","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T18:42:06Z","timestamp":1771353726000},"page":"e0342466","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatments for COVID-19 and acute respiratory infections are associated with gender and comorbidities in an Italian online 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plague in 16th-century Alghero, Sardinia","volume":"19","author":"R Bianucci","year":"2013","journal-title":"Emerg Infect Dis"},{"key":"pone.0342466.ref003","unstructured":"Italian Ministry of Health. doc.: 0024970-30\/11\/2020-DGPROGS-DGPROGS-P. 2020. https:\/\/www.simpios.eu\/wp-content\/uploads\/2020\/12\/MinistGestioneDomicilio30nov20.pdf"},{"issue":"7","key":"pone.0342466.ref004","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2022-250553","article-title":"Vitamin D intoxication and severe hypercalcaemia complicating nutritional supplements misuse","volume":"15","author":"A Alkundi","year":"2022","journal-title":"BMJ Case Rep"},{"issue":"14","key":"pone.0342466.ref005","doi-asserted-by":"crossref","first-page":"4726","DOI":"10.3390\/jcm12144726","article-title":"Safety profile of Vitamin D in Italy: an analysis of spontaneous reports of adverse reactions related to drugs and food supplements","volume":"12","author":"V Maggini","year":"2023","journal-title":"J Clin 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Cosentino","year":"2022","journal-title":"J Clin Med"},{"key":"pone.0342466.ref010","article-title":"Retrospective study of outcomes and hospitalization rates of patients in italy with a confirmed diagnosis of early COVID-19 and treated at home within 3 days or after 3 days of symptom onset with prescribed and non-prescribed treatments between November 2020 and August 2021","volume":"27","author":"S Fazio","year":"2021","journal-title":"Med Sci Monit"},{"issue":"1","key":"pone.0342466.ref011","doi-asserted-by":"crossref","first-page":"20964","DOI":"10.1038\/s41598-021-00243-4","article-title":"Treatment for COVID-19-a cohort study from Northern Italy","volume":"11","author":"L Guglielmetti","year":"2021","journal-title":"Sci Rep"},{"issue":"2","key":"pone.0342466.ref012","first-page":"93","article-title":"Self-reported compliance with drug therapy during the first SARS-CoV-2 Italian lockdown in patients with respiratory disease","volume":"58","author":"R 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Vaccine day, le prime vaccinazioni in Italia. https:\/\/www.salute.gov.it\/portale\/nuovocoronavirus\/dettaglioMaterialiNuovoCoronavirus.jsp?lingua=italiano&id=53&area=nuovoCoronavirus&menu=vuoto. Accessed 2024 June 15."},{"issue":"7821","key":"pone.0342466.ref016","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID-19-related death using OpenSAFELY","volume":"584","author":"EJ Williamson","year":"2020","journal-title":"Nature"},{"key":"pone.0342466.ref017","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna. 2024. https:\/\/www.R-project.org\/"},{"issue":"10","key":"pone.0342466.ref018","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1016\/S0277-9536(98)00440-7","article-title":"Gender, psychosocial factors and the use of medical services: a longitudinal analysis","volume":"48","author":"CA Green","year":"1999","journal-title":"Soc Sci Med"},{"issue":"1","key":"pone.0342466.ref019","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s13293-017-0155-5","article-title":"Sex differences in drugs: the development of a comprehensive knowledge base to improve gender awareness prescribing","volume":"8","author":"L Karlsson Lind","year":"2017","journal-title":"Biol Sex Differ"},{"issue":"1","key":"pone.0342466.ref020","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s12906-020-02903-w","article-title":"The use of complementary and alternative medicine (CAM) in Europe","volume":"20","author":"EL Fj\u00e6r","year":"2020","journal-title":"BMC Complement Med Ther"},{"issue":"5","key":"pone.0342466.ref021","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2012-002378","article-title":"Differences in drug utilisation between men and women: a cross-sectional analysis of all dispensed drugs in Sweden","volume":"3","author":"D Loikas","year":"2013","journal-title":"BMJ Open"},{"issue":"11","key":"pone.0342466.ref022","doi-asserted-by":"crossref","first-page":"3926","DOI":"10.3390\/ijerph17113926","article-title":"Gender differences in medication use: a drug utilization study based on real world data","volume":"17","author":"V Orlando","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0342466.ref023","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1177\/0013916596283003","article-title":"Gender and environmental risk concerns: a review and analysis of available research","volume":"28","author":"D Davidson","year":"1996","journal-title":"Environ Behav"},{"issue":"1","key":"pone.0342466.ref024","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1017\/S1930297500000346","article-title":"Gender differences in risk assessment: why do women take fewer risks than men?","volume":"1","author":"CR Harris","year":"2006","journal-title":"Judgm decis mak"},{"issue":"9459","key":"pone.0342466.ref025","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/S0140-6736(05)17907-0","article-title":"Outpatient antibiotic use in Europe and association with resistance: a cross-national database study","volume":"365","author":"H Goossens","year":"2005","journal-title":"Lancet"},{"issue":"1","key":"pone.0342466.ref026","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3390\/ijerph16010027","article-title":"Drivers of irrational use of antibiotics in Europe","volume":"16","author":"A Machowska","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0342466.ref027","unstructured":"AIFA. 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