Antibiotic effectiveness for children with lower respiratory infections : prospective cohort and trial in primary care
© The Authors..
BACKGROUND: Antibiotics are commonly prescribed for children with chest infections but there is little randomised evidence and trials commonly recruit selected populations, which undermines their applicability.
AIM: To document the effectiveness of antibiotics for chest infections in children.
DESIGN AND SETTING: This was a prospective cohort study with nested trial in primary care.
METHOD: Children aged 1-12 years presenting with uncomplicated lower respiratory tract infections were included in the cohort. Children were either randomised to receive amoxicillin 50 mg/kg per day for 7 days or placebo, or participated in a parallel observational study, where propensity scores controlled for confounding by indication. The outcomes were duration of symptoms rated moderately bad or worse (primary outcome) and illness progression requiring hospital assessment.
RESULTS: A total of 764 children participated (438 trial, 326 observational), and children were more unwell than in previous cohorts (more sputum, fever, shortness of breath). Children had been unwell for a median of 5-6 days, and symptoms rated moderately bad or worse lasted another 6 days when no antibiotics were given.With antibiotics there was a non-significant reduction of approximately 1 day in duration of symptoms rated moderately bad or worse for the whole cohort (hazard ratio [HR] 1.16, 95% confidence interval [CI] = 0.95 to 1.41), similar to the trial alone (HR 1.13, 95% CI = 0.90 to 1.43). The effect of antibiotic treatment on secondary outcomes was also non-significant.
CONCLUSION: Antibiotics for uncomplicated chest infections, even in a sample of more unwell children, are unlikely to be clinically very effective.
| Errataetall: |
CommentIn: Br J Gen Pract. 2023 Feb 23;73(728):100-101. - PMID 36823054 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:73 |
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| Enthalten in: |
The British journal of general practice : the journal of the Royal College of General Practitioners - 73(2023), 728 vom: 15. März, Seite e156-e163 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Little, Paul [VerfasserIn] |
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| Links: |
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| Themen: |
804826J2HU |
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| Anmerkungen: |
Date Completed 27.02.2023 Date Revised 01.03.2023 published: Electronic-Print CommentIn: Br J Gen Pract. 2023 Feb 23;73(728):100-101. - PMID 36823054 Citation Status MEDLINE |
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| doi: |
10.3399/BJGP.2022.0239 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM353292907 |
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| 245 | 1 | 0 | |a Antibiotic effectiveness for children with lower respiratory infections |b prospective cohort and trial in primary care |
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| 500 | |a Date Revised 01.03.2023 | ||
| 500 | |a published: Electronic-Print | ||
| 500 | |a CommentIn: Br J Gen Pract. 2023 Feb 23;73(728):100-101. - PMID 36823054 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Authors. | ||
| 520 | |a BACKGROUND: Antibiotics are commonly prescribed for children with chest infections but there is little randomised evidence and trials commonly recruit selected populations, which undermines their applicability | ||
| 520 | |a AIM: To document the effectiveness of antibiotics for chest infections in children | ||
| 520 | |a DESIGN AND SETTING: This was a prospective cohort study with nested trial in primary care | ||
| 520 | |a METHOD: Children aged 1-12 years presenting with uncomplicated lower respiratory tract infections were included in the cohort. Children were either randomised to receive amoxicillin 50 mg/kg per day for 7 days or placebo, or participated in a parallel observational study, where propensity scores controlled for confounding by indication. The outcomes were duration of symptoms rated moderately bad or worse (primary outcome) and illness progression requiring hospital assessment | ||
| 520 | |a RESULTS: A total of 764 children participated (438 trial, 326 observational), and children were more unwell than in previous cohorts (more sputum, fever, shortness of breath). Children had been unwell for a median of 5-6 days, and symptoms rated moderately bad or worse lasted another 6 days when no antibiotics were given.With antibiotics there was a non-significant reduction of approximately 1 day in duration of symptoms rated moderately bad or worse for the whole cohort (hazard ratio [HR] 1.16, 95% confidence interval [CI] = 0.95 to 1.41), similar to the trial alone (HR 1.13, 95% CI = 0.90 to 1.43). The effect of antibiotic treatment on secondary outcomes was also non-significant | ||
| 520 | |a CONCLUSION: Antibiotics for uncomplicated chest infections, even in a sample of more unwell children, are unlikely to be clinically very effective | ||
| 650 | 4 | |a Randomized Controlled Trial | |
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| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Hay, Alastair D |e verfasserin |4 aut | |
| 700 | 1 | |a Francis, Nick A |e verfasserin |4 aut | |
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