Do antibiotics prevent more severe infections in children up to five years old with common upper acute respiratory infections (ARIs)?
Common upper ARIs are a large and varied groups of infections. They occur in any part of the upper respiratory system, last for up to seven days and have a wide variety of causes. They may lead to complications such as ear, throat and sinus infections. More common in pre-school children, they are the most frequent reason for parents to seek medical assistance. Furthermore, they are responsible for 75% of the total prescribed antibiotics in high-income countries. One possible rationale for prescribing antibiotics is the wish to prevent bacterial complications.
This review focuses on the use of antibiotics to prevent clinical bacterial complications in children up to five years of age with common and undifferentiated ARIs. This is an update of a review previously published in 2014. The evidence is current to August 2015. In this update we retrieved 616 new studies, but none met our inclusion criteria.
We included four trials (1314 children) in this review. Three trials (414 children, during seven days) investigated the use of an antibiotic (amoxicillin/clavulanic acid) to prevent otitis media. One trial (889 children, during two weeks) investigated the use of another antibiotic (ampicillin) to prevent pneumonia. Only one trial addressed harms. However, we could not analyse the data as it was expressed in percentages rather then absolute terms. No studies assessed other severe complications (mastoiditis, quinsy, abscess, meningitis), hospital admission or death.
Current evidence does not provide support for the use of antibiotics to prevent otitis media and pneumonia in children up to five years of age with common upper ARIs.
Quality of the evidence
In the trials treating otitis media, the quality of the evidence was moderate as the methods for avoiding bias were not clearly stated. Furthermore, in one trial a pharmaceutical company prepared the placebo syrup used in the trial.
In the study treating pneumonia, we classified the quality of the evidence as moderate, because the families previously knew if their children were receiving antibiotics or not. Furthermore, the methods for avoiding bias were not clearly stated by the trial authors.
Further high-quality research is needed to provide more definitive evidence of the effectiveness of antibiotics in this population.
There is insufficient evidence for antibiotic use as a means of reducing the risk of otitis or pneumonia in children up to five years of age with undifferentiated ARIs. Further high-quality research is needed to provide more definitive evidence of the effectiveness of antibiotics in this population.