Systematic review of the treatment of upper respiratory tract infection.
OBJECTIVE
To assess the risks and benefits of antibiotic treatment in children with symptoms of upper respiratory tract infection (URTI).


METHODS
Quantitative systematic review of randomised trials that compare antibiotic treatment with placebo.


METHODS
Twelve trials retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists); no restriction on language.


METHODS
The proportion of children in whom the clinical outcome was worse or unchanged; the proportion of children who suffered complications or progression of illness; the proportion of children who had side effects.


RESULTS
1699 children were randomised in six trials that contributed to the meta-analysis. Six trials were not used in the meta-analysis because of different outcomes or incomplete data. Clinical outcome was not improved by antibiotic treatment (relative risk 1.01, 95% confidence interval (CI) 0.90 to 1.13), neither was the proportion of children suffering from complications or progression of illness (relative risk 0.71, 95% CI 0.45 to 1.12). Complications from URTI in the five trials that reported this outcome was low (range 2-15%). Antibiotic treatment was not associated with an increase in side effects compared with placebo (relative risk 0.8, 95% CI 0.54 to 1.21).


CONCLUSIONS
In view of the lack of efficacy and low complication rates, antibiotic treatment of children with URTI is not supported by current evidence from randomised trials.
Fahey
T
T
Division of Primary Care, University of Bristol, UK. tom.fahey@bris.ac.uk
Stocks
N
N
Thomas
T
T
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy*; D018570:Risk Assessment; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents