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Study supports narrow-spectrum antibiotics for pediatric respiratory infections

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December 19, 2017

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Jeffrey S. Gerber

Narrow-spectrum antibiotics are preferable to broad-spectrum antibiotics for treating most children with acute respiratory tract infections, according to a pair of studies published in JAMA.

The studies show that broad-spectrum antibiotics were not associated with better outcomes and resulted in more adverse events than narrow-spectrum antibiotics.

Jeffrey S. Gerber, MD, PhD, an attending physician in the division of infectious diseases at the Children’s Hospital of Philadelphia and a senior scholar with the Penn Center for Clinical Epidemiology and Biostatistics, and colleagues compared the effectiveness of the two treatment strategies in a retrospective cohort study that evaluated clinical outcomes and a prospective cohort study that focused on patient-centered outcomes. The studies included children aged 6 months to 12 years who were diagnosed with acute respiratory tract infections and prescribed oral antibiotics between January 2015 and April 2016. The children were treated in a network of 31 clinics in Pennsylvania and New Jersey.

The retrospective study included 4,296 patients who were prescribed broad-spectrum antibiotics and 25,790 who received narrow-spectrum antibiotics. At 14 days after diagnosis, treatment failure occurred in 3.4% of patients in the broad-spectrum treatment group, compared with 3.1% of those in the narrow-spectrum treatment group.

Also at 14 days, adverse events occurred in 3.7% of patients in the broad-spectrum treatment group, compared with 2.7% in the narrow-spectrum treatment group, the researchers said.

In the prospective study, the researchers assessed outcomes that included pediatric quality of life inventory scores. Among 860 patients who received broad-spectrum antibiotics, the researchers found a mean score of 90.2, compared with a mean score of 91.5 among 1,570 children who received narrow-spectrum drugs.

The broad-spectrum group had a higher rate of clinician-reported adverse events, at 3.7% vs. 2.7%, and a higher rate of patient-reported adverse events, at 35.6% vs. 25.1%.

The disparity between the groups in patient-reported events led the researchers to not only conclude that narrow-spectrum antibiotics are preferable for treating children with acute respiratory tract infections but also that clinicians should heed the input of patients and their guardians.

“Although adverse events rates were higher for broad-spectrum antibiotics in both cohorts, the overall rates of adverse events identified in the prospective cohort were 10.3 times the rate identified in the retrospective cohort, which reveals that (1) the majority of adverse events resulting from antibiotic use are not reported to (or documented by) prescribing clinicians and (2) assessing patient-centered outcomes might inform the risk-benefit ratio of antibiotic use in children,” they wrote. – by Joe Green

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Disclosures: Gerber reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.