noted in treatment failure between broad-spectrum and narrow-spectrum antibiotics (3.4% vs 3.1%; P5.88) and no risk difference in the full matched analysis, where patients prescribed broad-spectrum antibiotics were matched to patients prescribed narrow-spectrum antibiotics based on a propensity score from patient and clinic level characteristics (risk difference [RD] 0.3; 95% CI, -0.4 to 0.9). No difference was noted in treatment failure at 30 days between groups (8.7% vs 8.1%; P5.51) or in the full matched analysis (RD 0.6; 95% CI, -0.4 to 1.6). When stratified by diagnosis, patients receiving broad-spectrum antibiotics for streptococcal pharyngitis were at reduced risk for treatment failure compared with narrow-spectrum antibiotics (RD -1.3, 95% CI, -2.2 to -0.3). No difference was noted in treatment failure in patients with acute otitis media or acute sinusitis. Adverse events (diarrhea, vomiting, rash, etc) were higher at 14 days in the broad-spectrum group compared with narrow-spectrum group (3.7% vs 2.7%; P5.001). In the prospective analysis, broad-spectrum antibiotics had a slightly lower Pediatric Quality of Life Inventory score compared with narrow-spectrum antibiotics (90.2 vs 91.5; full-matched analysis RD -1.4; 95% CI, -2.4 to -0.4) but did not reach the prespecified four-point difference, indicating clinical significance. Broad-spectrum antibiotics were also associated with more adverse events than narrow-spectrum antibiotics (35.6% vs 25.1%; RD 12.2; 95% CI, 7.3-17.2).Bottom line: This study found that broad-spectrum antibiotics are not superior to narrow-spectrum antibiotics for pediatric respiratory infections, supporting the current practice of using the narrowest spectrum as possible when treating acute respiratory infections. This trial will help with talking points when explaining antibiotic choice to parents.
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