Largest trial of antibiotic amoxicillin for treating chest infections in children finds little effect

Date:
September 28, 2021
Source:
University of Bristol
Summary:
The largest randomized placebo-controlled trial of the antibiotic
amoxicillin for treating chest infections in children - one of the
most common acute illnesses treated in primary care in developed
countries, has found it is little more effective at relieving
symptoms than the use of no medication


FULL STORY ==========================================================================
The largest randomised placebo-controlled trial of the antibiotic
amoxicillin for treating chest infections in children -- one of the most
common acute illnesses treated in primary care in developed countries,
has found it is little more effective at relieving symptoms than the use
of no medication. The study, published in The Lancet and funded by the
National Institute for Health Research (NIHR), wasled by researchers
from the University of Southampton and supported by centres at the
Universities of Bristol, Oxford and Cardiff.


========================================================================== Although viruses are believed to cause many of these infections in
children, whether or not antibiotics are beneficial in treatment of chest infections in children is still debated. While research so far in adults
has shown that antibiotics are not effective for uncomplicated chest
infections until now, there has not been the same level of research
in children.

Researchers sought to test whether amoxicillin reduces the duration of moderately bad symptoms in children presenting with uncomplicated (non- pneumonic) lower respiratory tract chest infections in primary care. The
trial recruited 432 children aged six months to twelve years-old with
acute uncomplicated chest infections from primary care practices in
England and Wales who were then randomly assigned to receive either
amoxicillin or a placebo three times a day for seven days. Doctors
or nurse-prescribers assessed symptoms at the start of the study and
parents, with help from their children where possible, completed a daily symptom diary.

Only a small, non-significant, difference in the duration of symptoms
were reported between the two groups: children given the placebo had
symptoms which were rated moderately bad or worse for around 6 days on
average after seeing the doctor, and those given antibiotics got better
only 13 per cent quicker.

Furthermore, this was true even for the groups of children where the
doctor heard sounds in the chest, the child had a fever, where the
doctor rated the child as more unwell, the child coughed up phlegm or
had a rattly chest, or the child was short of breath.

Just four children in the placebo group and five in the antibiotic group required further assessment at hospital. The costs to parents, such as
the time needed to be off work or the cost of over-the-counter remedies,
was very similar in both groups.

Paul Little, Professor of Primary Care Research at the University
of Southampton and the study's lead author, said: "Children given
amoxycillin for chest infections where the doctor does not think the
child has pneumonia do not recover much more quickly.

"Indeed, using amoxicillin to treat chest infections in children
not suspected of having pneumonia is not likely to help and
could be harmful. Overuse of antibiotics, which is dominated by
prescribing of antibiotics in primary care, particularly when they are ineffective, can lead to side effects and the development of antibiotic resistance. Antibiotic resistance is one of the biggest threats to
the health of the public, and in future could make much of what is
currently routine medical practice very difficult or impossible -- such
having surgical operations or supporting people who are being treated
for cancer." Alastair Hay, a GP and Professor of Primary Care at the University of Bristol's Centre for Academic Primary Care, and one of the study's co-authors, added: "The ARTIC PC trial is one of the very few
studies to report on the effectiveness of prescribing antibiotics among
younger children presenting with chest infections in primary care. It was designed to be able to detect a clinically important 3-day improvement
in symptom duration.

"Our results suggest that unless pneumonia is suspected, clinicians
should provide 'safety-netting' advice such as explaining what illness
course to expect and when it would be necessary to re-attend but not
prescribe antibiotics for most children presenting with chest infections." ========================================================================== Story Source: Materials provided by University_of_Bristol. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. Paul Little, Nick A Francis, Beth Stuart, Gilly O'Reilly, Natalie
Thompson, Taeko Becque, Alastair D Hay, Kay Wang, Michael Sharland,
Anthony Harnden, Guiqing Yao, James Raftery, Shihua Zhu, Joseph
Little, Charlotte Hookham, Kate Rowley, Joanne Euden, Kim Harman,
Samuel Coenen, Robert C Read, Catherine Woods, Christopher C
Butler, Saul N Faust, Geraldine Leydon, Mandy Wan, Kerenza Hood,
Jane Whitehurst, Samantha Richards-Hall, Peter Smith, Michael
Thomas, Michael Moore, Theo Verheij.

Antibiotics for lower respiratory tract infection in children
presenting in primary care in England (ARTIC PC): a double-blind,
randomised, placebo-controlled trial. The Lancet, 2021; DOI:
10.1016/S0140-6736 (21)01431-8 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/09/210928102226.htm

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