Association of Broad-vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections

被引:166
|
作者
Gerber, Jeffrey S. [1 ,2 ,3 ]
Ross, Rachael K. [1 ]
Bryan, Matthew [3 ]
Localio, Russell [3 ]
Szymczak, Julia E. [3 ]
Wasserman, Richard [4 ]
Barkman, Darlene [5 ]
Odeniyi, Folasade [1 ]
Conaboy, Kathryn [5 ]
Bell, Louis [1 ,6 ]
Zaoutis, Theoklis E. [1 ,2 ,3 ]
Fiks, Alexander G. [1 ,3 ,6 ]
机构
[1] Childrens Hosp Philadelphia, Ctr Pediat Clin Effectiveness, Philadelphia, PA 19146 USA
[2] Childrens Hosp Philadelphia, Div Infect Dis, Philadelphia, PA 19104 USA
[3] Univ Penn, Dept Biostat Epidemiol & Informat, Perelman Sch Med, Philadelphia, PA 19104 USA
[4] Univ Vermont, Larner Coll Med, Burlington, VT 05405 USA
[5] Childrens Hosp Philadelphia, Div Patient & Family Experience, Family & Patient Serv Dept, Philadelphia, PA 19146 USA
[6] Childrens Hosp Philadelphia, Div Gen Pediat, Philadelphia, PA 19146 USA
来源
关键词
CLINICAL-PRACTICE GUIDELINE; ACUTE OTITIS-MEDIA; SENSITIVITY-ANALYSIS; RELIABILITY; VALIDITY; PEDSQL(TM)-4.0; FEASIBILITY; SINUSITIS; DIAGNOSIS; HEALTHY;
D O I
10.1001/jama.2017.18715
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IMPORTANCE Acute respiratory tract infections account for the majority of antibiotic exposure in children, and broad-spectrum antibiotic prescribing for acute respiratory tract infections is increasing. It is not clear whether broad-spectrum treatment is associated with improved outcomes compared with narrow-spectrum treatment. OBJECTIVE To compare the effectiveness of broad-spectrum and narrow-spectrum antibiotic treatment for acute respiratory tract infections in children. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study assessing clinical outcomes and a prospective cohort study assessing patient-centered outcomes of children between the ages of 6 months and 12 years diagnosed with an acute respiratory tract infection and prescribed an oral antibiotic between January 2015 and April 2016 in a network of 31 pediatric primary care practices in Pennsylvania and New Jersey. Stratified and propensity score-matched analyses to account for confounding by clinician and by patient-level characteristics, respectively, were implemented for both cohorts. EXPOSURES Broad-spectrum antibiotics vs narrow-spectrum antibiotics. MAIN OUTCOMES AND MEASURES In the retrospective cohort, the primary outcomes were treatment failure and adverse events 14 days after diagnosis. In the prospective cohort, the primary outcomes were quality of life, other patient-centered outcomes, and patient-reported adverse events. RESULTS Of 30 159 children in the retrospective cohort (19 179 with acute otitis media; 6746, group A streptococcal pharyngitis; and 4234, acute sinusitis), 4307 (14%) were prescribed broad-spectrum antibiotics including amoxicillin-clavulanate, cephalosporins, and macrolides. Broad-spectrum treatment was not associated with a lower rate of treatment failure (3.4% for broad-spectrum antibiotics vs 3.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 0.3%[95% CI, -0.4% to 0.9%]). Of 2472 children enrolled in the prospective cohort (1100 with acute otitis media; 705, group A streptococcal pharyngitis; and 667, acute sinusitis), 868 (35%) were prescribed broad-spectrum antibiotics. Broad-spectrum antibiotics were associated with a slightly worse child quality of life (score of 90.2 for broad-spectrum antibiotics vs 91.5 for narrow-spectrum antibiotics; score difference for full matched analysis, -1.4%[95% CI, -2.4% to -0.4%]) but not with other patient-centered outcomes. Broad-spectrum treatment was associated with a higher risk of adverse events documented by the clinician (3.7% for broad-spectrum antibiotics vs 2.7% for narrow-spectrum antibiotics; risk difference for full matched analysis, 1.1% [95% CI, 0.4% to 1.8%]) and reported by the patient (35.6% for broad-spectrum antibiotics vs 25.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 12.2%[95% CI, 7.3% to 17.2%]). CONCLUSIONS AND RELEVANCE Among children with acute respiratory tract infections, broad-spectrum antibiotics were not associated with better clinical or patient-centered outcomes compared with narrow-spectrum antibiotics, and were associated with higher rates of adverse events. These data support the use of narrow-spectrum antibiotics for most children with acute respiratory tract infections.
引用
收藏
页码:2325 / 2336
页数:12
相关论文
共 13 条
  • [1] Broad-spectrum antibiotics gave no clinical benefit and more adverse effects than narrow-spectrum antibiotics in treating acute respiratory tract infections in US children
    Lindbaek, Morten
    BMJ EVIDENCE-BASED MEDICINE, 2019, 24 (03) : 119 - 120
  • [3] Narrow-spectrum, compared with broad-spectrum, antibiotics equally effective with less adverse events
    Messacar, Kevin
    JOURNAL OF PEDIATRICS, 2018, 196 : 325 - 325
  • [6] Outcomes associated with initial narrow-spectrum versus broad-spectrum antibiotics in children hospitalized with urinary tract infections
    Markham, Jessica L.
    Burns, Alaina
    Hall, Matthew
    Molloy, Matthew J.
    Stephens, John R.
    Mccoy, Elisha
    Ugalde, Irma T.
    Steiner, Michael J.
    Cotter, Jillian M.
    House, Samantha A.
    Collins, Megan E.
    Yu, Andrew G.
    Tchou, Michael J.
    Shah, Samir S.
    JOURNAL OF HOSPITAL MEDICINE, 2024, 19 (09) : 777 - 786
  • [7] GENERAL CLINICAL STATUS OF BROAD-SPECTRUM ANTIBIOTICS RESPIRATORY AND INTESTINAL INFECTIONS - AN APPROACH TO ACUTE RESPIRATORY INFECTION IN CHILDREN
    DONALDSON, MH
    THURMAN, WG
    ANNALS OF THE NEW YORK ACADEMY OF SCIENCES, 1967, 145 (A2) : 367 - +
  • [8] Factors Associated with Prescribing Broad-Spectrum Antibiotics for Children with Upper Respiratory Tract Infections in Ambulatory Care Settings
    Alzahrani, Mohammad S.
    Maneno, Mary K.
    Daftary, Monika N.
    Wingate, La'Marcus
    Ettienne, Earl B.
    CLINICAL MEDICINE INSIGHTS-PEDIATRICS, 2018, 12
  • [9] Are children carrying the burden of broad-spectrum antibiotics in general practice? Prescription pattern for paediatric outpatients with respiratory tract infections in Norway
    Fossum, Guro Haugen
    Lindbaek, Morten
    Gjelstad, Svein
    Dalen, Ingvild
    Kvaerner, Kari J.
    BMJ OPEN, 2013, 3 (01):
  • [10] FACTORS ASSOCIATED WITH PRESCRIBING BROAD-SPECTRUM ANTIBIOTICS FOR CHILDREN WITH UPPER RESPIRATORY TRACT INFECTIONS IN AMBULATORY CARE SETTINGS, 2006-2010
    Alzahrani, M. S.
    Maneno, M. K.
    Daftary, M.
    Wingate, L.
    Ettienne, E. B.
    VALUE IN HEALTH, 2016, 19 (03) : A222 - A223