Antibiotics for uncomplicated chest infections are clinically ineffective even in a group of more unwell children, a UK trial has concluded.
Those taking part in the trial which compared a week-long course of amoxicillin with placebo found little difference even in those who had the most severe symptoms.
The trial of more than 750 one-to-12-year-olds with uncomplicated lower respiratory tract infection also included in a parallel observational study where antibiotic use was at the discretion of the GP or could include a delayed prescription.
It should provide confidence to GPs in advising on symptomatic management in this group of patients and giving clear guidance about when any repeat consultation might be needed to minimise antibiotic use, the researchers concluded in the British Journal of General Practice.
Study leader Professor Paul Little, professor of primary care research at the University of Southampton, said chest infections were one of the commonest reasons for children seeing a GP.
A previous Cochrane Review had found a dearth of evidence on the best approach for chest infections in children, he added.
Also, clinically trials may not typically include the same type of patients GPs see in everyday practice, he said.
But with the growing problem of antibiotic resistance it was important to research use of the medicines in those with more severe illness who GPs may feel they should prescribe just in case, the team outline in the paper.
The analysis combined both the randomised trial – which involved around 440 patients – and the observational study, and found less than a days’ difference between those who had antibiotics and those that did not.
Most children got better from the worst symptoms in about five to six days, Professor Little said.
‘It’s very reassuring really that even in a group of sicker children you’re not going to do terribly much for helping those moderately bad symptoms settle down.
‘If as a clinician you don’t suspect pneumonia and that’s the key thing, sick children with pneumonia or suspected pneumonia do need antibiotics.
‘We’re talking about the vast majority of children who present with a chest infection or chesty cough and might have some noises in their chest but actually it doesn’t really sound like pneumonia, it’s not a clinical picture of pneumonia.
‘Those children are very unlikely to benefit from antibiotics.’
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