Antibiotics for lower respiratory tract infection in children presenting in primary care in England (ARTIC PC): a double-blind, randomised, placebo-controlled trial

SPS commentary:

Similar findings were reported for key subgroups (patients with chest signs, fever, physician rating of unwell, sputum or chest rattle, and short of breath) in whom antibiotics are commonly prescribed. The researchers suggest that based on these data, unless pneumonia is suspected, safety-netting advice should be provided rather than prescribing antibiotics for most children presenting with chest infections.

According to a commentary, overtesting and overtreatment of children are especially prominent in infectious diseases, when fever or other symptoms such as cough can be unspecific and can be of viral or bacterial origin. It highlights that this trial provides more evidence that children with an uncomplicated lower respiratory tract infection (LRTI) do not benefit from treatment with antibiotics and symptoms such as fever, cough, or dyspnoea are not specific enough to identify the cause of an LRTI. It notes the trial aligns with other studies that have shown that reducing antibiotic treatment for LRTI is not associated with prolonged morbidity or higher incidence of complications. In addition, children could also benefit from a reduction in antibiotic prescriptions because it would result in fewer side-effects, especially in low-risk patients. It acknowledges that precautions should be taken when considering reducing antibiotic prescriptions for LRTIs in children at high risk of worse outcomes (e.g. those with concomitant diseases such as respiratory disease, heart disease, or immunodeficiency; or low birthweight). It also notes that parent cooperation is an important consideration when choosing treatment for uncomplicated LRTI in children.