Antibiotics for lower respiratory tract infection in children presenting in primary care (ARTIC-PC): the predictive value of molecular testing
Antibiotics for lower respiratory tract infection in children presenting in primary care (ARTIC-PC): the predictive value of molecular testing
Objectives: This study aimed to assess whether the presence of bacteria or viruses in the upper airway of children presenting with uncomplicated lower respiratory tract infection (LRTI) predicts the benefit of antibiotics. Methods: Children between 6 months and 12 years presenting to UK general practices with an acute LRTI were randomized to receive amoxicillin 50 mg/kg/d for 7 days or placebo. Children not randomized (ineligible or clinician/parental choice) could participate in a parallel observational study. The primary outcome was the duration of symptoms rated moderately bad or worse. Throat swabs were taken and analyzed for the presence of bacteria and viruses by multiplex PCR. Results: Swab results were available for most participants in the trial (306 of 432; 71%) and in the observational (182 of 326; 59%) studies. Bacterial pathogens potentially sensitive to amoxicillin (Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae) were detected among 51% of the trial placebo group and 49% of the trial antibiotic group. The median difference in the duration of symptoms rated moderately bad or worse between antibiotic and placebo was similar when potentially antibiotic-susceptible bacteria were present (median: –1 day; 99% CI, –12.3 to 10.3) or not present (median: –1 day; 99% CI, –4.5 to 2.5). Furthermore, bacterial genome copy number did not predict benefit. There were similar findings for all secondary outcomes and when including the data from the observational study. Discussion: There was no clear evidence that antibiotics improved clinical outcomes conditional on the presence or concentration of bacteria or viruses in the upper airway. Before deploying microbiologic point-of-care tests for children with uncomplicated LRTI in primary care, rigorous validating trials are needed.
Antimicrobial resistance, Bronchitis, Paediatrics, Primary care, Respiratory tract infections
1238-1244
Little, Paul
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Read, Robert C.
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Becque, Taeko
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Francis, Nick A.
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Hay, Alastair D.
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Stuart, Beth
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O'Reilly, Gilly
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Thompson, Natalie
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Hood, Kerenza
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Faust, Saul
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Wang, Kay
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Moore, Michael
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Verheij, Theo
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September 2022
Little, Paul
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Read, Robert C.
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Becque, Taeko
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Francis, Nick A.
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Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023
Stuart, Beth
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O'Reilly, Gilly
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Thompson, Natalie
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Hood, Kerenza
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Faust, Saul
f97df780-9f9b-418e-b349-7adf63e150c1
Wang, Kay
d5db72ee-6755-4f79-b8ce-d04e47167927
Moore, Michael
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Verheij, Theo
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Little, Paul, Read, Robert C., Becque, Taeko, Francis, Nick A., Hay, Alastair D., Stuart, Beth, O'Reilly, Gilly, Thompson, Natalie, Hood, Kerenza, Faust, Saul, Wang, Kay, Moore, Michael and Verheij, Theo
(2022)
Antibiotics for lower respiratory tract infection in children presenting in primary care (ARTIC-PC): the predictive value of molecular testing.
Clinical Microbiology and Infection, 28 (9), .
(doi:10.1016/j.cmi.2022.02.033).
Abstract
Objectives: This study aimed to assess whether the presence of bacteria or viruses in the upper airway of children presenting with uncomplicated lower respiratory tract infection (LRTI) predicts the benefit of antibiotics. Methods: Children between 6 months and 12 years presenting to UK general practices with an acute LRTI were randomized to receive amoxicillin 50 mg/kg/d for 7 days or placebo. Children not randomized (ineligible or clinician/parental choice) could participate in a parallel observational study. The primary outcome was the duration of symptoms rated moderately bad or worse. Throat swabs were taken and analyzed for the presence of bacteria and viruses by multiplex PCR. Results: Swab results were available for most participants in the trial (306 of 432; 71%) and in the observational (182 of 326; 59%) studies. Bacterial pathogens potentially sensitive to amoxicillin (Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae) were detected among 51% of the trial placebo group and 49% of the trial antibiotic group. The median difference in the duration of symptoms rated moderately bad or worse between antibiotic and placebo was similar when potentially antibiotic-susceptible bacteria were present (median: –1 day; 99% CI, –12.3 to 10.3) or not present (median: –1 day; 99% CI, –4.5 to 2.5). Furthermore, bacterial genome copy number did not predict benefit. There were similar findings for all secondary outcomes and when including the data from the observational study. Discussion: There was no clear evidence that antibiotics improved clinical outcomes conditional on the presence or concentration of bacteria or viruses in the upper airway. Before deploying microbiologic point-of-care tests for children with uncomplicated LRTI in primary care, rigorous validating trials are needed.
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Accepted/In Press date: 13 February 2022
e-pub ahead of print date: 11 March 2022
Published date: September 2022
Additional Information:
Acknowledgements: This project was funded by the Health Technology Assessment (HTA) Programme (study reference 13/34/64) of the NIHR. The views expressed in this publication are those of the author(s) and not necessarily those of the HTA, NHS, NIHR or the Department of Health. We are very grateful to both the TSC (Chair Elaine Hay) and the DMSC (Chair Sally Kerry) for their support and advice.
Keywords:
Antimicrobial resistance, Bronchitis, Paediatrics, Primary care, Respiratory tract infections
Identifiers
Local EPrints ID: 456560
URI: http://eprints.soton.ac.uk/id/eprint/456560
ISSN: 1198-743X
PURE UUID: 74e46963-4dcd-4198-9847-78cdc524f8c4
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Date deposited: 05 May 2022 16:31
Last modified: 12 Jul 2024 02:05
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Contributors
Author:
Alastair D. Hay
Author:
Gilly O'Reilly
Author:
Natalie Thompson
Author:
Kerenza Hood
Author:
Kay Wang
Author:
Theo Verheij
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