Narrow-spectrum antibiotics best for children with acute RTIs

(HealthDay)—For children with acute respiratory tract infections, broad-spectrum antibiotics are not associated with better clinical or patient-centered outcomes compared with narrow-spectrum antibiotics, according to a study published in the Dec. 19 issue of the Journal of the American Medical Association.

Jeffrey S. Gerber, M.D., Ph.D., from the Children's Hospital of Philadelphia, and colleagues compared the effectiveness of broad-spectrum and narrow-spectrum antibiotic treatment in a retrospective cohort study assessing clinical outcomes (30,159 children) and a prospective cohort study (2,472 children). The studies assessed patient-centered outcomes for children aged 6 months to 12 years diagnosed with acute respiratory tract infection and prescribed an oral antibiotic.

The researchers found that 14 percent of the children in the retrospective cohort study were prescribed broad-spectrum antibiotics. The rate of treatment failure was not lower for broad-spectrum treatment (3.4 percent, versus 3.1 percent for narrow-spectrum antibiotics; risk difference, 0.3 percent [95 percent confidence interval, −0.4 to 0.9 percent]). Thirty-five percent of the children in the prospective cohort were prescribed broad-spectrum antibiotics, which correlated with slightly worse quality of life (score, 90.2 for broad-spectrum antibiotics versus 91.5 for narrow-spectrum antibiotics; score difference, −1.4 percent [95 percent confidence interval, −2.4 to −0.4 percent]); no correlation was seen with other patient-centered outcomes. Increased risk of adverse events documented by the clinician and reported by the patients were seen with broad-spectrum treatment.

"These data support the use of narrow-spectrum antibiotics for most children with acute respiratory tract infections," the authors write.

Two authors disclosed financial ties to the biopharmaceutical industry.