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Antibiotics reduce neither the severity nor length of flu infections

Author Prof. J. Spranger, University Department of Pediatrics Mainz

Acute infections of the upper respiratory tract – i.e. colds, flu-like infections – are usually viral, but are often treated with antibiotics due to their acute nature and to prevent bacterial superinfections. A middle ground between immediate antibiotic prescription and no antibiotic prescription is delayed antibiotic prescription, i.e. the administration of antibiotics if the child’s condition, health and fever do not improve within a given period of time.
In a prospective study, 435 outpatient children with acute respiratory tract infections were randomised into three equally sized groups:
1. immediate antibiotic prescription,
2. no antibiotic prescription,
3. delayed antibiotic prescription [1].

In group 3, parents were told to administer antibiotics if their child had a fever of >39°C after one day or >38°C after 2 days, and if symptoms persisted after 4 days (for otitis media), 7 days (for pharyngitis), 15 days (for rhinosinusitis) or 20 days (for bronchitis). The respective waiting times had been explained to the parents in detail based on the natural history of the disease.

Results: The comparison of the 3 groups showed that the infections were of equal duration and severity. Only fever and subjective well-being improved somewhat more quickly with immediate administration of antibiotics (group 1). In general, antibiotic-treated children had more gastrointestinal complaints than children who went through a respiratory tract infection without antibiotics.

Comment: Overall, the very comprehensive study recommends a cautious administration of antibiotics for viral infections. What’s interesting about the methodology of the study are the prescribed waiting times and criteria until the inevitable administration of antibiotics against certain inflammations (group 3). They were based on statistics about the natural history of these diseases. In the end however, it all depends on the individual case, meaning that, for example, cases of streptococcal pharyngitis or acute otitis media with a bulging of the tympanic membrane require immediate administration of antibiotics.

[1] Maas-Dalmau G, Lopez CV, Gorrotxategi P, et al. Delayed antibiotic prescription for children with respiratory infections. A randomized trial. Pediatrics 2021; 147 (3): e20201323.