The largest randomised placebo-controlled trial of the antibiotic amoxicillin for treating paediatric chest infections has found it is little more effective at relieving symptoms than placebo.
While viruses are believed to cause many chest infections in children, whether antibiotics are effective in treating chest infections in children is still debated. In adults, research has shown that antibiotics are not effective for uncomplicated chest infections.
In the study, published in The Lancet, researchers sought to test whether amoxicillin reduces the duration of moderately bad symptoms in children presenting with uncomplicated (non-pneumonic) lower respiratory tract chest infections in primary care. The trial recruited 432 children aged six months to 12 years-old with acute uncomplicated chest infections from primary care practices, randomised to receive either amoxicillin or a placebo three times a day for seven days. Doctors or nurse-prescribers assessed symptoms at the start of the study and parents, with help from their children where possible, completed a daily symptom diary.
Only a small, non-significant, difference in symptom duration was seen between the two groups: children given the placebo had symptoms which were rated moderately bad or worse for around 6 days on average after seeing the doctor, and those given antibiotics only recovered 13% faster.
This held true even for groups where chest sounds were present, there was a fever, was rated more unwell by a doctor, coughing up phlegm or had a rattly chest, or the child was short of breath.
Just four children in the placebo group and five in the antibiotic group required further assessment at hospital. Parental costs such as leave taken or over-the-counter remedies, were very similar in both groups.
The study lead author, Professor Paul Little, said: “”Children given amoxycillin for chest infections where the doctor does not think the child has pneumonia do not recover much more quickly.
“Indeed, using amoxicillin to treat chest infections in children not suspected of having pneumonia is not likely to help and could be harmful. Overuse of antibiotics, which is dominated by prescribing of antibiotics in primary care, particularly when they are ineffective, can lead to side effects and the development of antibiotic resistance.”
Study co-author Alastair Hay, a GP and University of Bristol professor, added: “The ARTIC PC trial is one of the very few studies to report on the effectiveness of prescribing antibiotics among younger children presenting with chest infections in primary care. It was designed to be able to detect a clinically important 3-day improvement in symptom duration.
“Our results suggest that unless pneumonia is suspected, clinicians should provide ‘safety-netting’ advice such as explaining what illness course to expect and when it would be necessary to re-attend but not prescribe antibiotics for most children presenting with chest infections.”
Source: University of Bristol
