title: Antibiotics for bronchiolitis in children.
abstract: BACKGROUND
  Bronchiolitis is a serious, potentially life-threatening respiratory illness commonly affecting babies. It is often caused by respiratory syncytial virus (RSV). Antibiotics are not recommended for bronchiolitis unless there is concern about complications such as secondary bacterial pneumonia or respiratory failure. Nevertheless, they are used at rates of 34% to 99% in uncomplicated cases.
  
  
  OBJECTIVE
  To evaluate the effectiveness of antibiotics for bronchiolitis.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2010, issue 4), which includes the Cochrane Acute Respiratory Infection Group's Specialised Register, and the Database of Abstracts of Reviews of Effects, MEDLINE (January 1966 to November 2010), EMBASE (1990 to December 2010) and Current Contents (2001 to December 2010).
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing antibiotics to placebo in children under two years diagnosed with bronchiolitis, using clinical criteria (including respiratory distress preceded by coryzal symptoms with or without fever). Primary clinical outcomes included time to resolution of signs or symptoms (pulmonary markers included respiratory distress, wheeze, crepitations, oxygen saturation and fever). Secondary outcomes included hospital admissions, length of hospital stay, re-admissions, complications or adverse events and radiological findings.
  
  
  METHODS
  Two review authors independently analysed the search results.
  
  
  RESULTS
  Five studies (543 participants) met our inclusion criteria. One study randomised 52 children to either ampicillin or placebo and found no significant difference between the two groups for length of illness. A small study (21 children) with higher risk of potential bias randomised children with proven RSV infection to clarithromycin or placebo and found clarithromycin may reduce hospital re-admission (8% antibiotics versus 44% placebo; Fishers exact; P = 0.081). The two studies (267 children) providing adequate data for length of hospital stay showed no difference between antibiotics and control (pooled mean difference 0.34; 95% CI -0.71 to 1.38). Two studies randomised children to intravenous ampicillin, oral erythromycin and control and found no difference for most symptom measures. None of the trials reported deaths.
  
  
  CONCLUSIONS
  This review found minimal evidence to support the use of antibiotics for bronchiolitis. Research to identify a possible small subgroup of patients who have complications from bronchiolitis such as respiratory failure and who may benefit from antibiotics is justified.
authors.affiliation: Discipline of General Practice, Level 2, Edith Cavell Building, University of Queensland, Royal Brisbane Hospital, Brisbane, Queensland, Australia, 4029.
authors.forename: Geoffrey Kp
authors.initials: GK
authors.lastname: Spurling
authors.forename: Jenny
authors.initials: J
authors.lastname: Doust
authors.forename: Chris B
authors.initials: CB
authors.lastname: Del Mar
authors.forename: Lars
authors.initials: L
authors.lastname: Eriksson
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001988:Bronchiolitis / Q000188:drug therapy*; D017291:Clarithromycin / Q000627:therapeutic use; D004917:Erythromycin / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin; D000667:Ampicillin; D017291:Clarithromycin