A short-term treatment with amoxicillin was not clinically effective in children with uncomplicated chest infections, suggesting that safety-netting advice without antibiotics may be a better management choice for most children who present with chest infections, according to research findings published in the Lancet.
The double-blind trial included 432 children (median age, 3.2 years; 46% female) who presented to primary care in England with acute uncomplicated lower respiratory tract infections. Patients in the study had symptoms for less than 21 days. The study investigators randomly assigned patients to receive either 50 mg/kg/day amoxicillin (n=221) or placebo oral suspension (n=211) for 7 days.
During the treatment period, the researchers evaluated the duration of symptoms rated moderately bad or worse for up to 28 days or until resolution of symptoms occurred. Symptoms were assessed with a validated diary.
No significant difference was found between the antibiotics and placebo groups in terms of the median durations of moderately bad or worse symptoms (5 days vs 6 days, respectively; hazard ratio [HR], 1.13; 95% CI, 0.90–1.42). Additionally, no difference was found in terms of the median duration of symptoms until rated “absent” or “very little problem” (7 days vs 8 days; HR, 1.09; 95% CI, 0.86-1.38).
Approximately 30% of patients in the antibiotics group and 38% of patients in the placebo arm returned to their primary care provider with new or worsening symptoms (risk ratio [RR], 0.80; 95% CI, 0.58–1.05). There was also no difference between the treatment arms in regard to the proportions of patients that had side effects (38% vs 35%; RR, 1.20; 95% CI, 0.87-1.55).
The investigators explained that unless clinicians suspect pneumonia in children presenting with chest infections, they should offer their patients safety-netting advice that explains “what illness course to expect and when it would be necessary to reattend,” rather than prescribing antibiotics.
Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
Little P, Francis NA, Stuart B, et al. Antibiotics for lower respiratory tract infection in children presenting in primary care in England (ARTIC PC): a double-blind, randomised, placebo-controlled trial. Lancet. 2021;398(10309):1417-1426. doi:10.1016/S0140-6736(21)01431-8