Amoxicillin for uncomplicated chest infections in children is unlikely to be clinically effective, a new study finds

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The largest randomised placebo-controlled trial of amoxicillin for treating uncomplicated chest infections in children has found that it is unlikely to be clinically effective, either overall or for key subgroups, in whom antibiotics are commonly prescribed.

The ARTIC PC study, published in The Lancet and funded by the National Institute for Health Research, was led by researchers from the University of Southampton and supported by centres at the Universities of Bristol, Oxford, and Cardiff.

The 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 6 months–12 years with acute uncomplicated chest infections from 56 primary care practices in England and Wales, who were then randomly assigned to receive either amoxicillin at 50 mg/kg/day or a placebo oral suspension, three times a day for 7 days.

The median duration of moderately bad or worse symptoms was similar between the groups (5 days [interquartile range; IQR, 4–11] in the antibiotics group vs 6 days [IQR, 4–15] in the placebo group; HR, 1.13 [95% CI, 0.90-1.42]).

No differences were seen for the primary outcome between the treatment groups in the five prespecified clinical subgroups (patients with chest signs, fever, physician’s rating of unwell, sputum, or chest rattle and shortness of breath).

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

Unless pneumonia is suspected, clinicians should provide safety-netting advice but not prescribe antibiotics for most children presenting with chest infections, the authors concluded.

Paul Little, Professor of Primary Care Research at the University of Southampton and the study’s lead author, said 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.’

This article originally appeared on Univadis, part of the Medscape Professional Network.

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