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Broad-spectrum abx increase adverse events in children with acute respiratory infections with minimal benefit
Clinical Question
Are broad-spectrum antibiotics the preferred treatment in children with acute respiratory tract infections?
Bottom line
Broad-spectrum antibiotics are no more effective than narrow-spectrum antibiotics for treating acute respiratory tract infections in infants and children, and adverse events are significantly more common in children treated with broad-spectrum antibiotics. 2b-
Reference
Study design: Cohort (retrospective)
Funding: Government
Setting: Population-based
Synopsis
These investigators collected data both retrospectively and prospectively from a network of pediatric primary care practices on outcomes of infants and children, aged 6 months to 12 years, who met international standards for the diagnosis of acute respiratory tract infection, including otitis media, group A streptococcal pharyngitis, and sinusitis. Exclusion criteria included not receiving a prescription for an oral antibiotic, antibiotic use in the last 30 days, and being younger than 3 years with a diagnosis of group A streptococcal pharyngitis. The children who were prescribed broad-spectrum antibiotics, including amoxicillin-clavulanate, cephalosporins, and macrolides, were defined as exposed; children who were prescribed narrow-spectrum antibiotics, including penicillin and amoxicillin, were defined as unexposed. The authors do not specifically state whether the individuals who assessed outcomes remained masked to group assignments. Of the 30,159 children in the retrospective cohort that met inclusion criteria with complete data, 4307 (14%) were prescribed broad-spectrum antibiotics. Broad-spectrum antibiotic use was not significantly associated with a lower rate of treatment failure compared with narrow-spectrum antibiotics (3.4% vs 3.1%, respectively). Similarly broad-spectrum antibiotics were not associated with a clinically significant difference in quality of life scores compared with narrow-spectrum antibiotics. However, broad-spectrum antibiotics were significantly associated with a higher risk of reported adverse events compared with narrow-spectrum antibiotics (3.7% vs 2.7%, respectively, as documented by clinicians, and 35.6% vs 25.1%, respectively, as documented by the parents and/or patients). Adverse events included diarrhea, candidiasis, rash, other unspecified allergic reactions, and vomiting.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
good poem
Like it. Now if we could only further limit the unnecessary use of Amoxil.
I am reassured about not using indiscriminate prescribing of broad spectrum abx for children with acute URI.
This will help with handling pushy, concerned parents.
The Information presented on study,is not satisfactory , but as far as antibiotic concern if you can Identify or have culture and use less wide spectrum antibiotic will be beneficial,
Excellent
I try to avoid antibiotics as much as possible and, when using an antibiotic, concentrate on narrow spectrum antibiotics. I am beginning to think I should ask parents to collect a stool sample from the child and store it in the freezer so they can give the child an enema of their own stool once they have finished the antibiotics to restore their normal gut flora.
why were antibiotics prescribed for OM and sinusitis without specifying whether it was viral or bacteria. What did acute respiratory infection mean?
narrow spectrum antibiotics (penicillin)
The recent absence of penicillin elixir availability for children has hampered the appropriate management of GAS, and leads to increase in complications, as noted in this POEM. There appears to be little interest from manufacturers in remedying this issue.