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. (Level of Evidence = 2b–)

Synopsis

Investigators collected data retrospectively and prospectively from a network of pediatric primary care practices on outcomes of infants and children, six months to 12 years of age, 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 past 30 days, and being younger than three years with a diagnosis of group A streptococcal pharyngitis. The children who were prescribed broad-spectrum antibiotics, including amoxicillin/clavulanate (Augmentin), 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, 4,307 (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.

Study design: Cohort (retrospective)

Funding source: Government

Setting: Population-based

Reference:GerberJSRossRKBryanMet alAssociation of broad- vs narrow-spectrum antibiotics with treatment failure, adverse events, and quality of life in children with acute respiratory tract infections. JAMA2017;318(23):2325–2336.