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GPs advised to give antibiotics to children with flu

Antibiotics used in general practice are hardly ever of benefit for children with respiratory infections – but do speed recovery in those with flu.

A major new analysis of practice records found GPs prescribed antibiotics to a third of children with cough or fever, but with no effect on recovery time. The only exception, where prescribing antibiotics did appear to be justified, was for symptomatic treatment of flu.

Antibiotics significantly reduced the time a child with flu suffered from fever. The proportion who had recovered from fever five days after diagnosis was nearly 90 per cent with antibiotics, compared with a little over 60 per cent without.

Despite this, antibiotics were prescribed to only 24 per cent of children with confirmed flu, which the researchers said was too low when the virus was circulating in the community.

The study, published online in Archives of Disease in Childhood, backed current guidance that lower respiratory tract infections do not require antibiotics in the absence of complications. A viral cause was detected in 77 per cent of the 425 children studied, who were aged between six months and 12 years.

Study leader Dr Anthony Harnden, a lecturer in primary health care at the University of Oxford, said: 'The results demonstrate the clinical course of different viral infections is the same, whether or not the child gets antibiotics. The vast majority do not require them.

'The exception is fever caused by flu, because a number of children get secondary bacterial infections. Therefore, when flu is circulating, GPs should have a slightly lower threshold for using antibiotics.'

Dr Harnden, whose own practice in Wheatley, Oxfordshire, was one of 18 that participated in the study, said he thought the 'paradigm' that infections were either purely viral or bacterial was incorrect.

He said infections in general practice were likely to be a mixture of the two.

Dr Peter Fellows, a GP in Lydney, Gloucestershire, and chair of the GPC prescribing sub-committee, said the advice to consider giving children antibiotics if flu was circulating was sensible.

'It's all well and good saying 80-odd per cent of these infections are viral, but that means 20 per cent are not. And lower respiratory tract infections seldom occur in isolation.'

Key findings

• 77 per cent of children in primary care with 'more than a simple cold' have identifiable viral infection

• Symptoms resolved at very similar rates, irrespective of viral aetiology and antibiotic use

• Antibiotics may cut duration of fever in children with flu, which could reflect increased risk of secondary infection in these children

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