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Antibiotics for bronchiolitis in children
G K P Spurling1, K Fonseka, J Doust
1University of Queensland, Discipline of General Practice, Level 2, Edith Cavell Building, Royal Brisbane Hospital, Brisbane, Queensland, Australia, 4029. geoffspurling@optusnet.com.au
Insights
Antibiotics are not recommended for bronchiolitis, a common infant respiratory illness. A review found no evidence supporting their use, highlighting the need to understand why they are prescribed despite lack of benefit.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Bronchiolitis is a common, potentially severe respiratory illness in infants, often caused by RSV.
- Diagnosis is typically clinical, based on symptoms like rapid breathing and wheezing in children under two.
- Antibiotics are generally not advised for uncomplicated bronchiolitis, yet are frequently used.
Purpose of the Study:
- To evaluate the efficacy and necessity of antibiotic use in treating bronchiolitis.
Main Methods:
- Conducted a systematic search of major electronic databases for randomized controlled trials.
- Included studies compared antibiotic treatment (oral, IV, inhaled) to placebo in children under two diagnosed with bronchiolitis.
- Primary outcomes focused on symptom resolution, while secondary outcomes included hospital admissions and complications.
Main Results:
- Only one randomized controlled trial met the inclusion criteria.
- This study found no significant difference in illness duration or mortality between infants receiving ampicillin and those receiving a placebo.
- No deaths were reported in either treatment group.
Conclusions:
- The review found no evidence to support the use of antibiotics for bronchiolitis.
- The limited evidence necessitates caution; further research could explore specific subgroups who might benefit or investigate reasons for widespread antibiotic prescription.
- Focusing on reducing clinician anxiety and improving antibiotic stewardship is recommended.
Background:
Bronchiolitis is a serious, potentially life-threatening respiratory illness commonly affecting young babies. It is most often caused by Respiratory Syncytial Virus (RSV). The diagnosis is usually made on clinical grounds (especially tachypnoea and wheezing in a child less than two years of age). Antibiotics are not recommended for bronchiolitis unless there is concern about complications such as secondary bacterial pneumonia. Despite this, they are used at rates of 34 to 99% in uncomplicated cases.
Objectives:
To evaluate the use of antibiotics for bronchiolitis.
Search Strategy:
We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) which includes the Acute Respiratory Infection Groups' specialised register, the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library Issue 3, 2006); MEDLINE (January 1966 to August Week 2, 2006); EMBASE (1990 to March 2006); and Current Contents (2001 to September 2006).
Selection Criteria:
Types of studies: single or double blind randomised controlled trials comparing antibiotics to placebo in the treatment of bronchiolitis.
Types Of Participants:
children under the age of two years diagnosed with bronchiolitis using clinical criteria (including respiratory distress preceded by coryzal symptoms with or without fever). Types of interventions: oral, intravenous, intramuscular or inhaled antibiotics versus placebo. Types of outcome measures: primary clinical outcomes: time for the resolution of symptoms/signs (pulmonary markers: respiratory distress; wheeze; crepitations; oxygen saturation; and fever).
Secondary Outcomes:
hospital admissions; time to discharge from hospital; re-admissions; complications/adverse events developed; and radiological findings.
Data Collection And Analysis:
All data were analysed using Review Manager software, version 4.2.7.
Main Results:
One study met our inclusion criteria. It randomised children presenting clinically with bronchiolitis to either ampicillin or placebo. The main outcome measure was duration of illness and death. There was no significant difference between the two groups for length of illness and there were no deaths in either group.
Authors' Conclusions:
This review found no evidence to support the use of antibiotics for bronchiolitis. This results needs to be treated with caution given only one RCT justified inclusion. It is unlikely that simple RCTs of antibiotics against placebo for bronchiolitis will be undertaken in future. Research to identify a possible small subgroup of patients presenting with bronchiolitis-like symptoms who may benefit from antibiotics may be justified. Otherwise, research may be better focussed on determining the reasons for clinicians to use antibiotics so readily for bronchiolitis, and ways of reducing their anxiety, and therefore their use of antibiotics for bronchiolitis.
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