title: Respiratory infections for which general practitioners consider prescribing an antibiotic: a prospective study.
abstract: OBJECTIVE
  To determine the viral aetiology of respiratory infections in children presenting to primary care with "more than a simple cold".
  
  
  METHODS
  Observational study in 18 Oxfordshire general practices over four winters (2000-01 to 2003-04).
  
  
  METHODS
  425 children aged 6 months to 12 years with cough and fever for whom general practitioners considered prescribing an antibiotic.
  
  
  METHODS
  Nasopharyngeal aspirate obtained from 408 (96%) children was subjected to PCR for respiratory viruses. Parents completed an illness diary for the duration of illness.
  
  
  RESULTS
  A viral cause of infection was detected in most (77%) children. Clinical symptoms correctly identified the infecting virus in 45% of cases. The duration of illness was short and the time course was very similar for all infecting viruses. One third of children were prescribed an antibiotic (34%), but this made no difference to the rate of parent-assessed recovery (Kruskal-Wallis, p = 0.67). About one in five children with influenza who did not receive an antibiotic had persistent fever on day 7 compared to no children receiving antibiotics (p = 0.02); this difference remained after adjustment for severity and other factors and was not seen with other viruses.
  
  
  CONCLUSIONS
  Most children receiving antibiotics for respiratory symptoms in general practice have an identifiable viral illness. In routine clinical practice, neither the specific infecting virus nor the use of antibiotics has a significant effect on the time course of illness. Antibiotics may reduce the duration of fever in children with influenza which could reflect an increased risk of secondary bacterial infection for such children.
authors: Department of Primary Health Care, University of Oxford, Oxford, UK. anthony.harnden@dphpc.ox.ac.uk
authors: Anthony
authors: A
authors: Harnden
authors: Rafael
authors: R
authors: Perera
authors: Angela B
authors: AB
authors: Brueggemann
authors: Richard
authors: R
authors: Mayon-White
authors: Derrick W
authors: DW
authors: Crook
authors: Anne
authors: A
authors: Thomson
authors: David
authors: D
authors: Mant
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data*; D005334:Fever / Q000188:drug therapy; D006801:Humans; D007223:Infant; D009305:Nasopharynx / Q000821:virology; D009894:Opportunistic Infections / Q000188:drug therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000821:virology*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000175:diagnosis*
chemical_list: D000900:Anti-Bacterial Agents