A CME Journal For Family Physicians

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Narrow-Spectrum Antibiotics Best for Pediatric RTIs

The use of broad-spectrum antibiotics was not superior to narrow-spectrum antibiotics and was associated with more adverse events among children with acute respiratory tract infections, according to a recent study.
For their study, the researchers assessed clinical outcomes of 30,159 children between 6 months and 12 years of age enrolled in a retrospective study who were diagnosed with an acute respiratory tract infection and prescribed an oral antibiotic. In addition, they analyzed the patient-reported outcomes of 2472 children enrolled in a prospective cohort study and diagnosed with a respiratory tract infection. In the retrospective study, the primary outcomes included treatment failure and adverse events 14 days after diagnosis. In the prospective study, the primary outcomes included patient reported adverse events, quality of life, and other patient centered outcomes.
A total of 4307 (14%) patients in the retrospective study and 868 (35%) in the prospective study received broad- spectrum antibiotics, including amoxicillin-clavulanate, cephalosporins, and macrolides.
Overall, broad-spectrum antibiotics were not associated with lower treatment failure rates compared with narrow-spectrum antibiotics (3.4% vs 3.1%, respectively), but were associated with slightly worse quality of life compared with narrow-spectrum antibiotics. In addition, clinician-documented adverse events and patient-reported adverse events occurred more frequently among children who received broad-spectrum antibiotics.
“Among children with acute respiratory tract infections, broad-spectrum antibiotics were not associated with better clinical or patient-centered outcomes compared with narrow-spectrum antibiotics, and were associated with higher rates of adverse events,” the researchers concluded. “These data support the use of narrow-spectrum antibiotics for most children with acute respiratory tract infections.”

REFERENCE:
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 [December 19, 2017]. JAMA. doi:10.1001/jama.2017.18715.

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