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Antibiotics for childhood coughs


Another winter with its colds and coughs and grumpy people complaining either that their GP wouldn't give them or their children antibiotics, or if they did, the antibiotics didn't help. It sent Bandolier scurrying to find the systematic review [1] which showed the evidence that doctors don't prescribe antibiotics for colds for very good reasons.

Review


The review used an extremely broad search to find placebo-controlled studies of antibiotics in infants and children aged 0-12 years with onset of upper respiratory tract infection in the preceding two weeks. Infection was a pragmatic definition of acute inflammation of the nasal or pharyngeal mucosa in the absence of other defined respiratory infection.

Outcomes


These were:
  1. How many children were worse or unchanged on days 5-7.
  2. How many children suffered complications or progression of illness (otitis media, phayngitis, bronchitis or pneumonia).
  3. How many children had adverse effects (diarrhoea, vomiting, rash etc).

Results


Ten studies that matched the inclusion criteria were found, published between 1956 and 1994 and conducted in a variety of settings around the world. Four had no extractable data, and three of these concluded that antibiotics were of no benefit.

Results for the remaining six (1,700 children) were pretty uncompromising. For the proportion of children in whom the clinical outcome was unchanged or worse at 5-7 days there was no significant difference between antibiotic and placebo (Figure), with a relative risk of 1.0 (0.9 to 1.1).

Effect of antibiotics in children with upper respiratory tract infections




There was no difference between antibiotic and placebo in the number of children with complications or progression of illness (Figure), with a relative risk of 0.7 (0.5 to 1.1). There was no difference between antibiotic and placebo in the number of children with adverse effects, with a relative risk of 0.8 (0.5 to 1.2).

Comment


The wide variation in event rates seen in the Figure is not unusual, and probably reflects the wide temporal and geographic spread of the trials. There was no evidence that giving children antibiotics for uncomplicated upper respiratory tract infection has any value. Given the widespread concerns about antibiotic resistance, it probably does more harm than good.

Reference:

  1. T Fahey, N Stocks, T Thomas. Systematic review of the treatment of upper respiratory tract infection. Archives of Diseases in Childhood 1998 79: 225-230.



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