Comparing Broad- and Narrow-Spectrum Antibiotics for Children with Ear, Sinus, and Throat Infections

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What was the research about?

Antibiotics are the most commonly prescribed medicine in children. Narrow-spectrum antibiotics target a few types of bacteria. Broad-spectrum antibiotics target many types of bacteria. Both types work well to treat infections. But using broad-spectrum antibiotics when they’re not needed can create antibiotic-resistant bacteria that are hard to treat. They may also have side effects, such as diarrhea or rash.

In this study, the research team compared narrow-spectrum and broad-spectrum antibiotics to treat ear, sinus, and throat infections in children.

What were the results?

• Treating infections. Narrow-spectrum antibiotics worked as well as broad-spectrum antibiotics to treat infections. Symptoms improved the same amount in three days.
• Side effects. Children who took narrow-spectrum antibiotics had fewer side effects than those who took broad-spectrum antibiotics.
• Quality of life. There were no differences in quality of life between children who took broad- or narrow-spectrum antibiotics.

What did the research team do?

The research team did two studies. In both studies, children were ages 6 months to 12 years.

In the first, the research team looked at health records for 30,159 children who used broad- or narrow-spectrum antibiotics to treat ear, sinus, or throat infections. Of the children, 63 percent were white, 16 percent were mixed or another race, 12 percent were black, and 8 percent were Hispanic. The average age was 5, and 52 percent were boys. The team looked at how often treatment worked and whether patients had side effects in the month after diagnosis.

The second study included 2,472 children. All children had an ear, sinus, or throat infection. The research team interviewed parents and children about quality of life, how long symptoms lasted, and side effects after the children got antibiotics. Of the children, 59 percent were white, 23 percent were black, 8 percent were another race, and 9 percent were Hispanic. The average age was 5, and 52 percent were boys. All were patients at one of 31 children’s clinics in Pennsylvania or New Jersey.

Children, parents, and physicians helped plan and conduct the study.

What were the limits of the study?

Some children in the study may have had infections caused by viruses. Because antibiotics don’t treat viruses, the results could differ if only children with infections caused by bacteria were in the study.

Future research could study the two types of antibiotics in children with confirmed infections caused by bacteria.

How can people use the results?

Doctors and parents can use these results to make decisions about the type of antibiotic to use.

Objective

To compare the relative effectiveness of narrow- and broad-spectrum antibiotics in treating acute respiratory tract infections (ARTIs) in children

Study Design

Two observational cohort studies compared the effect of broad- and narrow-spectrum antibiotics on treatment failure, quality of life, and occurrence of side effects in children ages 6 months to 12 years with ARTIs, including acute otitis media, Group A streptococcal pharyngitis, and acute sinusitis.

For the retrospective study, researchers examined electronic health records for 30,159 children with ARTIs to determine the rate of treatment failure and side effects up to 30 days after diagnosis. Among children in the retrospective cohort, 63% were white, 16% were mixed or another race, 12% were black, and 8% were Hispanic. The average age was 5, and 52% were male.

For the prospective study, researchers enrolled 2,472 children ages 6 months to 12 years with ARTIs from 31 pediatric primary care practices in Pennsylvania and New Jersey. Among children in the prospective study, 59% were while, 23% were black, 8% were another race, and 9% were Hispanic. The average age was 5, and 52% were male. Researchers interviewed parents and children about quality of life, persistence of symptoms, and side effects.

Children, parents, and physicians helped plan and conduct the study.

Results

• Treatment failure rates: The rate of treatment failure was no different between children taking narrow- or broad-spectrum antibiotics.
• Symptom resolution: At 72 hours after diagnosis, the rate of symptom resolution was no different between children taking narrow- or broad-spectrum antibiotics.
• Side effects: The risk of side effects, including diarrhea, candidiasis, allergic reaction, and vomiting was significantly lower for children taking narrow-spectrum antibiotics compared with children taking broad-spectrum antibiotics (p<0.001).
• Quality of life. Narrow-spectrum antibiotics were associated with a higher health-related quality of life that was statistically (p=0.008) but not clinically different from broad-spectrum antibiotics.

Limitations

Some children may have had viral infections, which may limit the ability to detect between-group differences.

Conclusions and Relevance

Broad-spectrum antibiotics are not more effective than narrow-spectrum antibiotics in treating pediatric ARTIs. Narrow-spectrum antibiotics were associated with a lower risk of side effects.

Future Research Needs

Future research could restrict the study sample to children with confirmed bacterial infections.