Antibiotics not required in most childhood RTIs
It's hard not to take notice of a paper in a specialist journal whose principal author is a GP. Dr Harnden and his Oxfordshire-based team looked at children presenting to their network of research practices with symptoms of respiratory infection.
Children aged six months to 12 years with symptoms and signs thought to be more than an ordinary cold were selected for the study during four winters. The study recruited a large number of children, with 408 of the 425 recruited completing the study.
GPs were free to manage the child as they wished, in particular to prescribe antibiotics or not, but they were asked to rate the child on a severity scale prior to treatment.
Parents were asked to track the child on a symptom scale for the duration of the illness and to record the child's temperature. Once a child was diagnosed a research nurse visited the family to take a nasopharyngeal aspirate sample for virology studies.
Following analysis of the aspirates, viral infections were detected in 77% of children. Influenza (33%), respiratory syncytial virus (14%) and parainfluenza (14%) were the most common viruses identified.
It was not possible to see any particular clinical picture relating to individual viral infections from the presenting symptoms.
About one third of children were given antibiotics, most commonly amoxicillin. It was interesting to note that antibiotics seemed to make no significant difference to the time taken for recovery.
However, antibiotics reduced the duration and intensity of fever in influenza virus infections, probably by limiting secondary bacterial infection.
The authors use their results to reinforce the message that children with respiratory infections that are not severe do not need antibiotic treatment. They identify the need to explain the likely prognosis for such infections, as this may help limit demand for antibiotics.
It is hard to argue with a paper such as this, but sometimes pressure from parents is high; some antibiotics are given to treat their anxiety.
Harnden A, Perera R, Brueggemann AB et al. Respiratory infections for which general practitioners consider prescribing an antibiotic: a prospective study. Arch Dis Child 2007;92:594-597reviewerreviewer Reviewer
Dr Peter Saul
GP, Wrexham and hospital practitioner in paediatrics (asthma and allergy)