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Systematic review of the treatment of upper respiratory tract infection
1Division of Primary Care, University of Bristol, UK. tom.fahey@bris.ac.uk
Insights
Antibiotic treatment for children with upper respiratory tract infections (URTI) offers no clinical benefit and does not reduce complications. Current evidence from randomized trials does not support antibiotic use for URTI in pediatric patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Upper respiratory tract infections (URTI) are common in children.
- Antibiotics are frequently prescribed for pediatric URTI, despite concerns about efficacy and resistance.
Purpose of the Study:
- To evaluate the risks and benefits of antibiotic therapy in children diagnosed with URTI symptoms.
- To synthesize evidence from randomized controlled trials comparing antibiotics to placebo for pediatric URTI.
Main Methods:
- A quantitative systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
- Data were extracted from twelve identified trials, with six trials included in the meta-analysis.
- Outcomes assessed included clinical outcomes, complications, progression of illness, and side effects.
Main Results:
- Antibiotic treatment did not improve clinical outcomes for children with URTI (RR 1.01, 95% CI 0.90 to 1.13).
- No significant reduction in complications or illness progression was observed with antibiotic use (RR 0.71, 95% CI 0.45 to 1.12).
- The incidence of side effects was similar between antibiotic and placebo groups (RR 0.8, 95% CI 0.54 to 1.21).
Conclusions:
- Current evidence from randomized trials does not support the use of antibiotics for children with URTI due to lack of efficacy.
- Low rates of complications associated with URTI further argue against routine antibiotic prescription.
- This systematic review highlights the need to reconsider antibiotic prescribing practices for pediatric URTI.
Objectives:
To assess the risks and benefits of antibiotic treatment in children with symptoms of upper respiratory tract infection (URTI).
Design:
Quantitative systematic review of randomised trials that compare antibiotic treatment with placebo.
Data Sources:
Twelve trials retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists); no restriction on language.
Main Outcome Measures:
The proportion of children in whom the clinical outcome was worse or unchanged; the proportion of children who suffered complications or progression of illness; the proportion of children who had side effects.
Results:
1699 children were randomised in six trials that contributed to the meta-analysis. Six trials were not used in the meta-analysis because of different outcomes or incomplete data. Clinical outcome was not improved by antibiotic treatment (relative risk 1.01, 95% confidence interval (CI) 0.90 to 1.13), neither was the proportion of children suffering from complications or progression of illness (relative risk 0.71, 95% CI 0.45 to 1.12). Complications from URTI in the five trials that reported this outcome was low (range 2-15%). Antibiotic treatment was not associated with an increase in side effects compared with placebo (relative risk 0.8, 95% CI 0.54 to 1.21).
Conclusions:
In view of the lack of efficacy and low complication rates, antibiotic treatment of children with URTI is not supported by current evidence from randomised trials.