Are broad-spectrum antibiotics the preferred treatment in children with acute respiratory tract infections?

Broad-spectrum antibiotics are no more effective than narrow-spectrum antibiotics for treating acute respiratory tract infections in infants and children, and adverse events are significantly more common in children treated with broad-spectrum antibiotics. (LOE = 2b-)

Gerber JS, Ross RK, Bryan M, et al. Association of broad- vs narrow-spectrum antibiotics with treatment failure, adverse events, and quality of life in children with acute respiratory tract infections. JAMA 2017;318(23):2325-2336.  [PMID:29260224]

Cohort (retrospective)

Government

Population-based

These investigators collected data both retrospectively and prospectively from a network of pediatric primary care practices on outcomes of infants and children, aged 6 months to 12 years, who met international standards for the diagnosis of acute respiratory tract infection, including otitis media, group A streptococcal pharyngitis, and sinusitis. Exclusion criteria included not receiving a prescription for an oral antibiotic, antibiotic use in the last 30 days, and being younger than 3 years with a diagnosis of group A streptococcal pharyngitis. The children who were prescribed broad-spectrum antibiotics, including amoxicillin-clavulanate, cephalosporins, and macrolides, were defined as exposed; children who were prescribed narrow-spectrum antibiotics, including penicillin and amoxicillin, were defined as unexposed. The authors do not specifically state whether the individuals who assessed outcomes remained masked to group assignments. Of the 30,159 children in the retrospective cohort that met inclusion criteria with complete data, 4307 (14%) were prescribed broad-spectrum antibiotics. Broad-spectrum antibiotic use was not significantly associated with a lower rate of treatment failure compared with narrow-spectrum antibiotics (3.4% vs 3.1%, respectively). Similarly broad-spectrum antibiotics were not associated with a clinically significant difference in quality of life scores compared with narrow-spectrum antibiotics. However, broad-spectrum antibiotics were significantly associated with a higher risk of reported adverse events compared with narrow-spectrum antibiotics (3.7% vs 2.7%, respectively, as documented by clinicians, and 35.6% vs 25.1%, respectively, as documented by the parents and/or patients). Adverse events included diarrhea, candidiasis, rash, other unspecified allergic reactions, and vomiting.