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

Abstract 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.
PMID
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Authors

Mayor MeshTerms

Quality of Life

Keywords
Journal Title jama
Publication Year Start




PMID- 29260224
OWN - NLM
STAT- MEDLINE
DCOM- 20180108
LR  - 20180108
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 318
IP  - 23
DP  - 2017 Dec 19
TI  - Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure,
      Adverse Events, and Quality of Life in Children With Acute Respiratory Tract
      Infections.
PG  - 2325-2336
LID - 10.1001/jama.2017.18715 [doi]
AB  - 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 30159 children in the 
      retrospective cohort (19179 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.
FAU - Gerber, Jeffrey S
AU  - Gerber JS
AD  - Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia,
      Philadelphia, Pennsylvania.
AD  - Division of Infectious Diseases, Children's Hospital of Philadelphia,
      Philadelphia, Pennsylvania.
AD  - Department of Biostatistics, Epidemiology and Informatics, Perelman School of
      Medicine, University of Pennsylvania, Philadelphia.
FAU - Ross, Rachael K
AU  - Ross RK
AD  - Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia,
      Philadelphia, Pennsylvania.
FAU - Bryan, Matthew
AU  - Bryan M
AD  - Department of Biostatistics, Epidemiology and Informatics, Perelman School of
      Medicine, University of Pennsylvania, Philadelphia.
FAU - Localio, A Russell
AU  - Localio AR
AD  - Department of Biostatistics, Epidemiology and Informatics, Perelman School of
      Medicine, University of Pennsylvania, Philadelphia.
FAU - Szymczak, Julia E
AU  - Szymczak JE
AD  - Department of Biostatistics, Epidemiology and Informatics, Perelman School of
      Medicine, University of Pennsylvania, Philadelphia.
FAU - Wasserman, Richard
AU  - Wasserman R
AD  - Larner College of Medicine, University of Vermont, Burlington.
FAU - Barkman, Darlene
AU  - Barkman D
AD  - Division of Patient and Family Experience, Family and Patient Services
      Department, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
FAU - Odeniyi, Folasade
AU  - Odeniyi F
AD  - Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia,
      Philadelphia, Pennsylvania.
FAU - Conaboy, Kathryn
AU  - Conaboy K
AD  - Division of Patient and Family Experience, Family and Patient Services
      Department, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
FAU - Bell, Louis
AU  - Bell L
AD  - Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia,
      Philadelphia, Pennsylvania.
AD  - Division of General Pediatrics, Children's Hospital of Philadelphia,
      Philadelphia, Pennsylvania.
FAU - Zaoutis, Theoklis E
AU  - Zaoutis TE
AD  - Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia,
      Philadelphia, Pennsylvania.
AD  - Division of Infectious Diseases, Children's Hospital of Philadelphia,
      Philadelphia, Pennsylvania.
AD  - Department of Biostatistics, Epidemiology and Informatics, Perelman School of
      Medicine, University of Pennsylvania, Philadelphia.
FAU - Fiks, Alexander G
AU  - Fiks AG
AD  - Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia,
      Philadelphia, Pennsylvania.
AD  - Department of Biostatistics, Epidemiology and Informatics, Perelman School of
      Medicine, University of Pennsylvania, Philadelphia.
AD  - Division of General Pediatrics, Children's Hospital of Philadelphia,
      Philadelphia, Pennsylvania.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Cephalosporins)
RN  - 0 (Macrolides)
RN  - 74469-00-4 (Amoxicillin-Potassium Clavulanate Combination)
SB  - AIM
SB  - IM
MH  - Acute Disease
MH  - Amoxicillin-Potassium Clavulanate Combination/adverse effects/therapeutic use
MH  - Anti-Bacterial Agents/*adverse effects/therapeutic use
MH  - Cephalosporins/adverse effects/therapeutic use
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Macrolides/adverse effects/therapeutic use
MH  - Male
MH  - Otitis Media/*drug therapy
MH  - Pharyngitis/drug therapy
MH  - Primary Health Care
MH  - *Quality of Life
MH  - Respiratory Tract Infections/*drug therapy
MH  - Retrospective Studies
MH  - Sinusitis/drug therapy
MH  - Streptococcal Infections/drug therapy
MH  - Streptococcus pyogenes
MH  - Treatment Failure
EDAT- 2017/12/21 06:00
MHDA- 2018/01/09 06:00
CRDT- 2017/12/21 06:00
PHST- 2017/12/21 06:00 [entrez]
PHST- 2017/12/21 06:00 [pubmed]
PHST- 2018/01/09 06:00 [medline]
AID - 2666503 [pii]
AID - 10.1001/jama.2017.18715 [doi]
PST - ppublish
SO  - JAMA. 2017 Dec 19;318(23):2325-2336. doi: 10.1001/jama.2017.18715.