Philadelphia—With an especially challenging season for influenza-related complications and other respiratory infections, pharmacists are filling a lot of antibiotic prescriptions for children.

A new study suggests that choosing agents with narrower targets is usually better than employing broad-spectrum antibiotics. And the reason is not just good antibiotic stewardship.

The study published recently in JAMA involved 30,000 children with earaches, strep throat, and other common infections. It found that narrow-spectrum antibiotics generally performed as well as those with bigger targets but did so with fewer adverse effects.

“Many children unnecessarily receive broad-spectrum antibiotics for common infections, which can lead to antibiotic resistance and unnecessary side effects,” explained study leader Jeffrey Gerber, MD, PhD, associate director for Inpatient Research Activities in the Center for Pediatric Clinical Effectiveness at Children’s Hospital of Philadelphia (CHOP). “This study showed that inappropriate prescribing of antibiotics also affects families at a much more practical level, such as missed days from school and work, side effects of the drugs, and costs for extra childcare. These can be a real burden for families.”

Results were from two complementary studies performed at 31 primary-care practices in CHOP’s pediatric network in Pennsylvania and New Jersey between January 2015 and April 2016. Electronic health records of infants and children up to age 12 diagnosed with an acute respiratory tract infection (ARTI) and prescribed an oral antibiotic were employed. The research showed that 14% of the children received broad-spectrum drugs versus 86% who received narrow-spectrum drugs.

Along with the retrospective analysis, the study team focused on a cohort of 2,472 children, conducting telephone interviews with caregivers to measure certain outcomes —adverse drug effects, additional childcare costs, lingering symptoms, and missed school days. Those were identified as parent’s greatest concerns when their child had a respiratory infection.

Broad-spectrum antibiotics were found to create a higher risk of adverse events compared to narrow-spectrum antibiotics—3.7% versus 2.7%, respectively, as documented by clinicians—and 35.6% versus 25.1%, respectively, as reported by patients and caregivers.

Specifically, of 30,159 children in the retrospective cohort—19,179 with acute otitis media; 6,746 with group A streptococcal pharyngitis; and 4,234 with acute sinusitis—4,307 were prescribed broad-spectrum antibiotics including amoxicillin-clavulanate, cephalosporins, and macrolides. The study further emphasizes that broad-spectrum treatment was not associated with a lower rate of treatment failure—3.4% for broad-spectrum antibiotics versus 3.1% for narrow-spectrum antibiotics.

Of 2,472 children enrolled in the prospective cohort—1,100 with acute otitis media; 705 with group A streptococcal pharyngitis; and 667 with acute sinusitis—35% were prescribed broad-spectrum antibiotics. 

The problem, according to the research team, is that broad-spectrum antibiotics lowered quality of life for children unnecessarily.

“Among children with acute respiratory tract infections, broad-spectrum antibiotics were not associated with better clinical or patient-centered outcomes compared with narrow-spectrum antibiotics, and were associated with higher rates of adverse events,” study authors conclude. “These data support the use of narrow-spectrum antibiotics for most children with acute respiratory tract infections.”
« Click here to return to Weekly News Update.