Short-term treatment with amoxicillin is clinically ineffective in children with uncomplicated chest infections, according to findings published in The Lancet, suggesting that for most children with chest infections, no antibiotics A safety net recommendation may be a better management option.
The double-blind trial included 432 children (median age 3.2 years; 46% women) receiving primary care in England for acute uncomplicated lower respiratory tract infection.Patients in the study had symptoms for less than 21 days.The researchers randomly assigned patients to receive 50 mg/kg/day of amoxicillin (n=221) or a placebo oral suspension (n=211) for 7 days.
During treatment, researchers assessed symptom duration for up to 28 days or until symptoms resolved.Symptoms were assessed using a validated diary.
There was no significant difference between the antibiotic and placebo groups in median duration of symptoms of moderate or severe severity (5 and 6 days, respectively; hazard ratio [HR], 1.13; 95% CI, 0.90- 1.42).In addition, no difference was found in median duration of symptoms before being rated as “absent” or “very few problems” (7 days vs 8 days; HR, 1.09; 95% CI, 0.86-1.38).
Approximately 30% of patients in the antibiotic group and approximately 38% in the placebo group returned to their primary care provider with new or worsening symptoms (hazard ratio [RR], 0.80; 95% CI, 0.58–1.05).There was also no difference between treatment groups in the proportion of patients with adverse effects (38% vs 35%; RR, 1.20; 95% CI, 0.87-1.55).
Rather than prescribing antibiotics, unless clinicians suspect pneumonia in a child with a chest infection, they should provide patients with safety net advice explaining “what course of illness is expected and when revisiting is necessary,” the researchers explained.
Little P, Francis NA, Stewart B, et al.Antibiotics for Lower Respiratory Tract Infections in Primary Care Children in England (ARTIC PC): A Double-Blind, Randomized, Placebo-Controlled Trial.Lancet.2021;398(10309):1417-1426.doi: 10.1016/S0140-6736(21)01431-8
Post time: Jun-24-2022