Objective To determine the expected duration of symptoms of common respiratory tract infections in children in primary and emergency care.Design Systematic review of existing literature to determine durations of symptoms of earache, sore throat, cough (including acute cough, bronchiolitis, and croup), and common cold in children.Data sources PubMed, DARE, and CINAHL (all to July 2012).Eligibility criteria for selecting studies Randomised controlled trials or observational studies of children with acute respiratory tract infections in primary care or emergency settings in high income countries who received either a control treatment or a placebo or over-the-counter treatment. Study quality was assessed with the Cochrane risk of bias framework for randomised controlled trials, and the critical appraisal skills programme framework for observational studies.Main outcome measures Individual study data and, when possible, pooled daily mean proportions and 95% confidence intervals for symptom duration. Symptom duration (in days) at which each symptom had resolved in 50% and 90% of children. ResultsOf 22 182 identified references, 23 trials and 25 observational studies met inclusion criteria. Study populations varied in age and duration of symptoms before study onset. In 90% of children, earache was resolved by seven to eight days, sore throat between two and seven days, croup by two days, bronchiolitis by 21 days, acute cough by 25 days, common cold by 15 days, and non-specific respiratory tract infections symptoms by 16 days. ConclusionsThe durations of earache and common colds are considerably longer than current guidance given to parents in the United Kingdom and the United States; for other symptoms such as sore throat, acute cough, bronchiolitis, and croup the current guidance is consistent with our findings. Updating current guidelines with new evidence will help support parents and clinicians in evidence based decision making for children with respiratory tract infections.

BackgroundRespiratory tract infections (RTIs) in children are common and often result in antibiotic prescription despite their typically self-limiting course. AimTo assess the effectiveness of primary care based interventions to reduce antibiotic prescribing for children with RTIs. Design and settingSystematic review. Method MEDLINE ®, Embase, CINAHL ® , PsycINFO, and the Cochrane library were searched for randomised, cluster randomised, and nonrandomised studies testing educational and/or behavioural interventions to change antibiotic prescribing for children (<18 years) with RTIs. Main outcomes included change in proportion of total antibiotic prescribing or change in 'appropriate' prescribing for RTIs. Narrative analysis of included studies was used to identify components of effective interventions. ResultsOf 6301 references identified through database searching, 17 studies were included. Interventions that combined parent education with clinician behaviour change decreased antibiotic prescribing rates by between 6-21%; structuring the parent-clinician interaction during the consultation may further increase the effectiveness of these interventions. Automatic computerised prescribing prompts increased prescribing appropriateness, while passive information, in the form of waiting room educational materials, yielded no benefit. ConclusionConflicting evidence from the included studies found that interventions directed towards parents and/or clinicians can reduce rates of antibiotic prescribing. The most effective interventions target both parents and clinicians during consultations, provide automatic prescribing prompts, and promote clinician leadership in the intervention design. Keywordsanti-bacterial agents, children, prescriptions, primary health care, respiratory tract infections.e445 British Journal of General Practice, July 2013 (from inception through June 2012) were searched using terms for RTIs, children, parents, education, antibiotic prescription, and consultation (Table 1). One author screened titles and abstracts based on predefined inclusion criteria to identify relevant studies and reviewed reference lists and related citations of selected studies to identify additional references. Two authors reviewed the full-text of selected studies to determine inclusion. Disagreements were settled through discussions with a third author.Controlled studies were included that used a randomised, cluster randomised, non-randomised or one-group pre-and post-test design to assess the effectiveness of educational or behavioural interventions to change clinicians' antibiotic prescribing for acute RTIs in children (birth to 18 years) in primary care settings (family practice, emergency, or paediatric primary care). Outcomes of interest were change in proportion of antibiotic prescriptions issued for RTIs in children, or change in 'appropriate' antibiotic prescribing. Comparisons included no-treatment or alternate treatment controls. Studies were excluded if they were: from in-patient settings; evaluations of...