title: Clinical outcomes in Mexican children with febrile acute upper respiratory tract infections: no impact of antibiotic therapy.
abstract: OBJECTIVE
  To compare the clinical outcomes (duration of signs and symptoms) and the microbiology in Mexican children with non-complicated febrile upper respiratory tract infections (URI), with and without the use of antibiotics.
  
  
  METHODS
  We conducted a prospective cohort study from September 2006 to July 2007. The study population consisted of 880 children aged 6 months to 5 years 11 months, attending four community daycare centers run by the Instituto Mexicano del Seguro Social (IMSS) and three non-IMSS daycare centers. Children with a febrile URI were enrolled before receiving any antimicrobials and were followed up for two weeks. Duration of the fever, cough, runny nose, stuffy nose, irritability, loss of appetite, tiredness, and diarrhea, and isolation of Haemophilus influenzae,Streptococcus pneumoniae, and Streptococcus pyogenes were compared in those children who received antibiotic treatment and those who did not receive antibiotics.
  
  
  RESULTS
  During the study period, a total of 145 out of 880 children were enrolled, and among those enrolled, 85/145 (59%) children received antibiotics. There was no significant difference in the duration of the signs and symptoms evaluated in the two groups. Although the proportions of S. pneumoniae, H. influenzae, and S. pyogenes isolated in children with and without antibiotics were comparable, those in whom we isolated S. pneumoniae had both a significantly longer episode of URI, as well as longer lasting diarrhea. Similarly, children receiving trimethoprim-sulfamethoxazole treatment experienced significantly longer durations of fever and diarrhea.
  
  
  CONCLUSIONS
  The mean duration of signs and symptoms and the microbiological isolates of children with febrile URI were comparable among children treated with or without antibiotics, with the exception of a longer duration of URI and diarrhea in those children with an S. pneumoniae isolate. Our findings suggest that in our population, most cases of febrile URI are caused by viral infections, and demonstrate that antibiotics should not be used routinely in children with non-complicated febrile URI.
authors.affiliation: Molecular Microbiology Laboratory, Centro de Investigación Biomédica de Occidente, IMSS, Sierra Mojada 800, Col. Independencia, CP 44340, Guadalajara, Jalisco, Mexico.
authors.forename: Martha I
authors.initials: MI
authors.lastname: Carranza-Martinez
authors.forename: Oscar
authors.initials: O
authors.lastname: Newton-Sanchez
authors.forename: Carlos
authors.initials: C
authors.lastname: Franco-Paredes
authors.forename: Alberto
authors.initials: A
authors.lastname: Villaseñor-Sierra
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002656:Child Day Care Centers; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D006193:Haemophilus influenzae / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D008800:Mexico; D009305:Nasopharynx / Q000382:microbiology; D011379:Prognosis; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000187:drug effects / Q000302:isolation & purification; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents