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Treating respiratory infections: narrow or broad-spectrum antibiotics?

Researchers investigated the efficacy and safety of narrow or broad-spectrum antibiotics for upper respiratory tract infections in children.

Ear, sinus, and throat infections are the most commonly diagnosed infections in children, and antibiotics are often prescribed. Guidelines for prescribing antibiotics differ greatly. The American Academy of Pediatrics typically recommends the use of narrow-spectrum antibiotics, whereas the Infectious Diseases Society of America recommends broad-spectrum antibiotics. One theory for the preference of broad-spectrum antibiotics is the bacterial shift of infections due to the pneumococcal vaccination. The bacterial balance in the environment may have shifted away from pneumococcal bacteria to beta-lactamase-producing bacteria, which are resistant to narrow-spectrum antibiotics.

The primary goal of antibiotic treatment is infection resolution. However, prescribers must consider that the overuse of broad-spectrum antibiotics is a cause of antibiotic resistance and may affect patient quality of life due to increased side effect reporting. Researchers at the Children’s Hospital of Philadelphia conducted a two-part cohort study comparing the effectiveness of broad- versus narrow-spectrum antibiotics and patient-centered outcomes in children with acute respiratory tract infections. The results of this study were published in the Journal of the American Medical Association.

Broad Spectrum Antibiotics Were Not More Effective Statistically

In the first part of the study, a retrospective analysis was performed on 30,086 children receiving oral antibiotics for an acute upper respiratory tract infection, of which 4,296 patients received broad-spectrum antibiotics. The results of the study show that broad-spectrum antibiotics were not statistically more effective than narrow-spectrum antibiotics. Similar treatment failure rates were observed between both groups of patients. The patients receiving broad-spectrum antibiotics reported more side effects than those receiving narrow-spectrum antibiotics. This efficacy study supports the use of narrow-spectrum antibiotics for most children with upper respiratory tract infections.

Narrow-Spectrum Antibiotics for Upper Respiratory Tract Infections

The second part of the study involved a prospective observation of patient-centered outcomes associated with antibiotic treatment. Patients or their guardians were interviewed and questions were posed concerning child suffering, attendance records for both guardians and children, sleep disturbances, side effects, and speed of symptom resolution. The researchers used the Pediatric Quality of Life Inventory to measure patient-centered outcomes. In this cohort study, children and guardians also reported more side effects with broad-spectrum antibiotics. In addition, a worse quality of life score was observed among children receiving broad-spectrum antibiotics. Other patient-centered outcomes studied were similar between both treatment groups. This second part of the study also confirms the preference for the use of narrow-spectrum antibiotics for upper respiratory tract infections in most children.

Study Limitations

One limitation of this study is the possibility that children may have been misdiagnosed and were actually infected with a virus, therefore not requiring antibiotic treatment. This would inflate the results of the clinical outcomes investigation. Furthermore, the Pediatric Quality of Life Inventory used for the analysis of patient-centered outcomes has never been validated for acute respiratory tract infections.

For acute upper respiratory tract infections in children, broad-spectrum antibiotics are not more effective than narrow-spectrum antibiotics. Broad-spectrum antibiotics score worse on quality of life measures and are associated with more side effects. This study further supports the use of narrow-spectrum antibiotics over broad-spectrum antibiotics for treating upper respiratory tract infections in most children.

Written by Jessica Caporuscio, PharmD

Reference: Gerber JS, Ross RK, Bryan M, et al. Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections. JAMA. 2017.

Jessica Caporuscio PharmD
Jessica Caporuscio PharmD
Jessica received her Doctorate of Pharmacy from the University of Montreal in July 2014 and she has been working as a community pharmacist in the Greater Toronto Area since March 2015. She has a passion to communicate medical and drug information to her patients and other healthcare professionals. Jessica is also a marathoner and an Ironman triathlete. In her spare time, she is in her kitchen creating healthy recipes for her family.
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