Antibiotics for lower respiratory tract infection in children presenting in primary care (ARTIC-PC): the predictive value of molecular testing

Little, Paul; Read, Robert C.; Becque, Taeko; Francis, Nick; Stuart, Beth; O’Reilly, Gilly; Thompson, Natalie; Hood, Kerenza; Faust, Saul N; Moore, Michael; Verheij, Theo

doi:10.1016/j.cmi.2022.02.033

Cited by 5 publications

(2 citation statements)

References 26 publications

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“…The estimates of benefit for both the above subgroups were also not very important clinically (neither subgroup had a difference in symptom duration of more than 2 days). If, as the current study suggests, antibiotics are not effective this may be in part due to antibiotics not working for infections caused predominantly by viruses -but we have shown that bacterial infections were common in this cohort, and that the presence of bacteria did not predict benefit from antibiotics 40 . It may also be in part that the time course of the inflammatory process is more important, or possibly antibiotic resistance.…”

Section: Strengths and Limitationsmentioning

confidence: 59%

“…If, as the current study suggests, antibiotics are not effective this may be in part because of antibiotics not working for infections caused predominantly by viruses — but the authors of the current study in a previous publication have shown that bacterial infections were common in this cohort, and that the presence of bacteria did not predict benefit from antibiotics. 40 It may also be in part that the time course of the inflammatory process is more important, or possibly antibiotic resistance.…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic effectiveness for children with lower respiratory infections: prospective cohort and trial in primary care

Little

Becque²,

Francis³

et al. 2022

Br J Gen Pract

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Background: Antibiotics are commonly prescribed for children with chest infections, but there is little randomised evidence, and trials commonly recruit selected populations which undermines their applicability. Aim: To document the effectiveness of antibiotics for chest infections in children. Design: Prospective cohort study with nested trial. Setting Primary care Methods: Children aged one to twelve presenting with uncomplicated lower respiratory tract infections were included in the cohort. Children were either randomised to receive Amoxicillin 50mg/kg/day/7 days or placebo, or participated in a parallel observational study, where propensity scores controlled for confounding by indication. Outcomes: duration of symptoms rated moderately bad or worse (primary outcome); illness progression requiring hospital assessment. Results: 758 children participated (432 trial, 326 observational), and children were more unwell than in previous cohorts (more sputum, fever, shortness of breath). Children had been unwell for a median of 6 days, and symptoms rated moderately bad or worse lasted another 6 days when no antibiotics were given. With antibiotics there was a non significant reduction of approximately a day in duration of symptoms rated moderately bad or worse for the whole cohort (Hazard ratio 1.16 (0.95, 1.41), similar to the trial alone ( HR1.13, 95% CIs 0.90,1.43). ). The effect of antibiotic treatment on secondary outcomes was also non-significant. Conclusion: Antibiotics for uncomplicated chest infections, even in a sample of more unwell children, are unlikely to be clinically very effective.

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Section: Strengths and Limitationsmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%