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Updated: Jul 16, 2026
Microbiological Rapid On-Site Evaluation for Pulmonary Infectious Diseases
Published on: March 1, 2024
Respiratory infections for which general practitioners consider prescribing an antibiotic: a prospective study
Anthony Harnden1, Rafael Perera, Angela B Brueggemann
1Department of Primary Health Care, University of Oxford, Oxford, UK. anthony.harnden@dphpc.ox.ac.uk
Insights
Most children with respiratory infections have viral causes, and antibiotics don't significantly alter illness duration. Influenza patients receiving antibiotics may have shorter fever duration.
Area of Science:
- Pediatrics
- Infectious Diseases
- General Practice/Primary Care
Background:
- Respiratory infections are common in children presenting to primary care.
- Distinguishing viral from bacterial infections is crucial for appropriate antibiotic use.
Purpose of the Study:
- To identify the viral causes of respiratory infections in children in primary care.
- To assess the impact of antibiotics on illness duration and recovery.
Main Methods:
- An observational study involving 425 children (6 months-12 years) with cough and fever.
- Nasopharyngeal aspirates analyzed by PCR for respiratory viruses.
- Parental illness diaries recorded symptom duration.
Main Results:
- A viral cause was detected in 77% of children.
- Antibiotic prescription (34%) did not affect overall recovery rates.
- Influenza patients not receiving antibiotics had prolonged fever (day 7).
Conclusions:
- The majority of childhood respiratory infections in primary care are viral.
- Antibiotic use has minimal impact on the clinical course of most viral respiratory illnesses.
- Antibiotics might shorten fever duration in influenza, potentially indicating a higher risk of secondary bacterial infection.
Objective:
To determine the viral aetiology of respiratory infections in children presenting to primary care with "more than a simple cold".
Design:
Observational study in 18 Oxfordshire general practices over four winters (2000-01 to 2003-04).
Patients:
425 children aged 6 months to 12 years with cough and fever for whom general practitioners considered prescribing an antibiotic.
Methods:
Nasopharyngeal aspirate obtained from 408 (96%) children was subjected to PCR for respiratory viruses. Parents completed an illness diary for the duration of illness.
Results:
A viral cause of infection was detected in most (77%) children. Clinical symptoms correctly identified the infecting virus in 45% of cases. The duration of illness was short and the time course was very similar for all infecting viruses. One third of children were prescribed an antibiotic (34%), but this made no difference to the rate of parent-assessed recovery (Kruskal-Wallis, p = 0.67). About one in five children with influenza who did not receive an antibiotic had persistent fever on day 7 compared to no children receiving antibiotics (p = 0.02); this difference remained after adjustment for severity and other factors and was not seen with other viruses.
Conclusions:
Most children receiving antibiotics for respiratory symptoms in general practice have an identifiable viral illness. In routine clinical practice, neither the specific infecting virus nor the use of antibiotics has a significant effect on the time course of illness. Antibiotics may reduce the duration of fever in children with influenza which could reflect an increased risk of secondary bacterial infection for such children.
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