Systematic review of the treatment of upper respiratory tract infection

Abstract

Objectives-To assess the risks and benefits of antibiotic treatment in children with symptoms of upper respiratory tract infection (URTI). Design-Quantitative systematic review of randomised trials that compare antibiotic treatment with placebo. Data sources-Twelve trials retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists); no restriction on language. Main outcome measures-The proportion of children in whom the clinical outcome was worse or unchanged; the proportion of children who suVered complications or progression of illness; the proportion of children who had side eVects. Results-1699 children were randomised in six trials that contributed to the meta-analysis. Six trials were not used in the meta-analysis because of diVerent outcomes or incomplete data. Clinical outcome was not improved by antibiotic treatment (relative risk 1.01, 95% confidence interval (CI) 0.90 to 1.13), neither was the proportion of children suVering from complications or progression of illness (relative risk 0.71, 95% CI 0.45 to 1.12). Complications from URTI in the five trials that reported this outcome was low (range 2-15%). Antibiotic treatment was not associated with an increase in side eVects compared with placebo (relative risk 0.8, 95% CI 0.54 to 1.21). Conclusions-In view of the lack of eYcacy and low complication rates, antibiotic treatment of children with URTI is not supported by current evidence from randomised trials. (Arch Dis Child 1998;79:225-230)

Predictors of inappropriate antibiotic prescribing among primary care physicians

“…The International Classification of Diseases (ninth revision ) codes used are listed in Appendix 1 (available online at www.cmaj.ca/cgi/content/full /177/8/877/DC2). Viral cultures are seldom performed in community-care settings; thus, our classification of respiratory infections as having a likely viral etiology was based on the diagnosis (i.e., common cold, influenza, viral pneumonia) and on evidence from etiologic and antibiotic treatment studies 21,22 (i.e., acute laryngitis, unspecified acute upper respiratory tract infection). We excluded episodes that were preceded by a similar infection in the year before diagnosis.…”

“…Classification of antibiotics as first-, second-or third-line was based on published treatment guidelines (Appendix 2, available online at at www.cmaj.ca/cgi /content/full/177/8/877/DC2). 24 We defined the appropriate treatment of a likely bacterial infection either as treatment with a first-line antibiotic, or as the absence of antibiotic treatment because a proportion of infections categorized as potentially bacterial are expected to have a viral cause 21,22 (e.g., > 90% of cases of acute bronchitis have a viral cause; 25 thus, no antibiotic treatment is appropriate).…”

Costo/efficacia della prevenzione di infezioni alle prime vie aeree mediante un estratto batterico immunostimolante aspecifico (OM-85)

“…l a t e i n o r t s e a M ] 5 [ ) 4 8 9 1 ( i s e m 6 3 + 3 i n n a 6 1 -1 0 2 : Z P 1 1 : O 9 : P 9 , 1 : O 4 , 5 : P e p u a P ] 6 [ ) 1 9 9 1 ( i s e m 6 3 + 3 i n n a 9 1 -5 , 0 6 1 1 : Z P 1 6 : O 5 5 : P 6 6 0 , 2 : O 9 0 5 , 3 : P . l a t e z e r é P -a r a J ] 7 [ ) 0 0 0 2 ( i s e m 6 3 + 3 i n n a 3 1 -6 9 9 1 : Z P 9 9 : O 0 0 1 : P 4 4 , 1 : O 9 9 , 2 : P e n o i z a r t s i n i m m o s i d i l c i c Il 69% dei casi di infezione alle vie aeree superiori ha un decorso favorevole non complicato senza trattamento antibatterico [11][12][13].…”

“…Complessivamente le altre complicanze compaiono nel 4% circa dei casi di URTI [9,11,12]. Singolarmente, ognuna di queste complicanze (tonsillite, laringite, bronchite, ecc), ha un'incidenza significativamente minore rispetto ai casi di OMA o di sinusite; per tale ragione è stato assunto che si risolvano con la terapia indicata come prima scelta dalle principali linee guida, in quanto la probabilità di ulteriore aggravamento o di ospedalizzazione risulterebbe trascurabile rispetto agli altri eventi modellizzati.…”

Study of drug use in outdoor pediatric patients of upper respiratory tract infections in a tertiary care hospital

“…7,8 Only 10% of URTI has been attributable to bacterial etiology. 9 Common cold does not require antimicrobial agents unless it is complicated by acute otitis media with effusion, tonsillitis, sinusitis and lower respiratory tract infection. 10 The management of URTI of viral origin involves symptomatic treatment like antihistamines, antipyretics or anti-inflammatory agents, cough suppressants (such as dextromethorphan), expectorants and decongestants.…”