Appropriate use of antibiotics for URIs in children: Part II. Cough, pharyngitis and the common cold. The Pediatric
S F Dowell1, B Schwartz, W R Phillips
1Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
This article advises against unnecessary antibiotic use for common illnesses like cough, pharyngitis, and colds. Judicious antimicrobial therapy is crucial, especially in children, to combat antibiotic resistance.
Area of Science:
- General Medicine
- Infectious Diseases
- Pharmacology
Background:
- Antimicrobial resistance is a growing public health concern.
- Outpatient antibiotic prescriptions are frequently used for viral infections.
- Cough, pharyngitis, and the common cold are leading reasons for antibiotic prescriptions.
Purpose of the Study:
- To summarize evidence-based principles for judicious antimicrobial therapy.
- To guide appropriate antibiotic use for common outpatient conditions.
- To reduce unnecessary antibiotic prescriptions for viral illnesses.
Main Methods:
- Literature review of studies on antimicrobial therapy for cough, pharyngitis, and the common cold.
- Analysis of evidence supporting or refuting antibiotic use in these conditions.
- Synthesis of guidelines for judicious antimicrobial prescribing.
Main Results:
- Antibiotic treatment is not recommended for most cough or bronchitis in children.
- Withholding antibiotics for pharyngitis until confirmed bacterial infection is advised.
- The common cold never warrants antibiotic treatment, even with persistent symptoms.
Conclusions:
- Judicious antimicrobial therapy is essential to combat resistance.
- Understanding the natural history of viral infections is key to appropriate prescribing.
- Evidence supports limiting antibiotic use for cough, pharyngitis, and common cold.
Abstract:
This article summarizes the principles of judicious antimicrobial therapy for three of the five conditions--cough, pharyngitis, the common cold--that account for most of the outpatient use of these drugs in the United States. The principles governing the other two conditions, otitis media and acute sinusitis, were presented in the previous issue. This article summarizes evidence against the use of antibiotic treatment for illness with cough or bronchitis in children, unless the cough is prolonged. Although empiric treatment may be started in patients with pharyngitis when streptococcal infection is suspected, the authors recommend withholding antibiotic treatment until antigen testing or culture is positive. There is never any indication for antibiotic treatment of the common cold; it is important to understand the natural history of colds, because symptoms such as mucopurulent rhinitis or cough, even when they persist for up to two weeks, do not necessarily indicate bacterial infection.
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