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When Should Antibiotics be Prescribed for Acute Cough?

Prescription of antibiotics does little to prevent hospitalization in children who present in primary care with cough and respiratory symptoms, according to a recent study.
Despite the dangers of overuse and “limited meaningful evidence of impact” on major outcomes, antibiotics are often prescribed to children presenting with cough and respiratory symptoms, according to the study authors.
In an effort to estimate the effects of antibiotic use on adverse outcomes 30 days after initial presentation, the researchers conducted a multicenter prospective cohort study involving 8320 children aged 3 months to <16 years who presented in primary care with acute cough and other respiratory symptoms.
The effect of antibiotics on adverse outcomes, defined as subsequent hospitalization and reconsultation for deterioration, was assessed using generalized linear models.
Overall, 65 (0.8%) of the children were hospitalized and 350 (4%) were reconsulted for deterioration. Antibiotics (immediate and delayed) were prescribed to 2313 (28%) and 771 (9%) of the children, respectively.
When comparing children who were given antibiotics with those who were not, the researchers found that there was no clear evidence that antibiotics reduced the risk of hospitalization (risk ratio 0.83 for immediate antibiotics and 0.70 for delayed antibiotics). There was, however, evidence that delayed antibiotics reduced rates of reconsultations for deterioration (risk ratio for immediate antibiotics 0.82 vs 0.55 for delayed antibiotics).
“These results provide reassurance that, when faced with a child and uncertain prognosis, delayed prescribing can be a safe and effective method to reduce the child’s probability of reconsulting with deterioration and can act as part of safety-netting strategies for parents,” the researchers concluded.

REFERENCE:
Redmond NM, Turnbull S, Stuart B, et al. Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study [published online September 10, 2018] Br J Gen Pract. doi:https://doi.org/10.3399/bjgp18X698873.

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