title: Risk-benefit analysis of restricting antimicrobial prescribing in children: what do we really know?
abstract: OBJECTIVE
  Most childhood respiratory infections including acute otitis media (AOM), sore throat, upper respiratory tract infections (URTIs) and sinusitis are self-limiting illnesses. Yet, despite extensive guidance discouraging routine use of antibiotics to limit side-effects and combat antimicrobial resistance, antibiotic prescribing for these conditions remains high in many developed countries, fuelled by the fear of rare but serious bacterial complications including mastoiditis, quinsy, pneumonia and brain abscess. This review summarizes evidence for the role of antibiotics in preventing serious complications of URTIs in children.
  
  
  RESULTS
  From a key observational study reporting antibiotic use in children, the calculated excess risk of suppurative complications of respiratory tract infections in children who did not receive an antibiotic was 3.8 per 10 000. Despite extensive searches of the literature, no data were found to assess the affect of antibiotics upon the risk of brain abscess after sinusitis in children.
  
  
  CONCLUSIONS
  New information from observational studies suggests antibiotics show little benefit in preventing complications of mastoiditis following AOM, quinsy following sore throat and pneumonia following URTI/bronchitis. Further research should focus on stratifying the key risk factors for such complications and optimizing long-term monitoring strategies to detect any future changes in the risk-benefit analysis for antibiotic prescription.
authors.affiliation: Department of Primary Care and Social Medicine, Imperial College London, London, UK.
authors.forename: Tamara
authors.initials: T
authors.lastname: Keith
authors.forename: Sonia
authors.initials: S
authors.lastname: Saxena
authors.forename: Joanna
authors.initials: J
authors.lastname: Murray
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards*; D006291:Health Policy; D006801:Humans; D055656:Prescriptions / Q000592:standards*; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy*; D018570:Risk Assessment
chemical_list: D000900:Anti-Bacterial Agents