The University of Southampton
University of Southampton Institutional Repository

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
Antibiotics for lower respiratory tract infection in children presenting in primary care (ARTIC-PC): the predictive value of molecular testing

Objective: to assess whether the presence of bacteria or viruses in the upper airway of children presenting with uncomplicated lower respiratory tract infection (LRTI) predicts benefit from antibiotics.

Methods: children between 6 months and twelve years old presenting to UK general practices with an acute LRTI were randomised to receive amoxicillin 50mg/kg/day/7 days, or placebo. Children not randomised (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 analysed for the presence of bacteria and viruses by multiplex PCR (Polymerase Chain Reaction).

Results: swab results were available for most participants in the trial (306/432[71%]) and in the observational (182/326 [59%]) studies. Bacterial pathogens potentially sensitive to amoxicillin (H.influenzae, M.catarrhalis, S.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.

Conclusions: 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 microbiological POC tests for children with uncomplicated LRTI in primary care rigorous validating trials are needed.

1198-743X
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Read, Robert C.
b5caca7b-0063-438a-b703-7ecbb6fc2b51
Becque, Taeko
ecd1b4d5-4db8-4442-81c2-04aa291cf2fd
Francis, Nick A.
9b610883-605c-4fee-871d-defaa86ccf8e
Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
O'Reilly, Gilly
f66a0310-7e33-4ca7-bb85-8e7a0e780a5d
Thompson, Natalie
f2803da0-85a3-456a-98d0-3b09b3adf9ef
Hood, Kerenza
62906d76-4931-4b12-9a64-0c867c7b84c1
Faust, Saul
f97df780-9f9b-418e-b349-7adf63e150c1
Wang, Kay
d5db72ee-6755-4f79-b8ce-d04e47167927
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Verheij, Theo
55c456f3-cc01-4a27-907f-7b79d987d102
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Read, Robert C.
b5caca7b-0063-438a-b703-7ecbb6fc2b51
Becque, Taeko
ecd1b4d5-4db8-4442-81c2-04aa291cf2fd
Francis, Nick A.
9b610883-605c-4fee-871d-defaa86ccf8e
Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
O'Reilly, Gilly
f66a0310-7e33-4ca7-bb85-8e7a0e780a5d
Thompson, Natalie
f2803da0-85a3-456a-98d0-3b09b3adf9ef
Hood, Kerenza
62906d76-4931-4b12-9a64-0c867c7b84c1
Faust, Saul
f97df780-9f9b-418e-b349-7adf63e150c1
Wang, Kay
d5db72ee-6755-4f79-b8ce-d04e47167927
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Verheij, Theo
55c456f3-cc01-4a27-907f-7b79d987d102

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. (doi:10.1016/j.cmi.2022.02.033).

Record type: Article

Abstract

Objective: to assess whether the presence of bacteria or viruses in the upper airway of children presenting with uncomplicated lower respiratory tract infection (LRTI) predicts benefit from antibiotics.

Methods: children between 6 months and twelve years old presenting to UK general practices with an acute LRTI were randomised to receive amoxicillin 50mg/kg/day/7 days, or placebo. Children not randomised (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 analysed for the presence of bacteria and viruses by multiplex PCR (Polymerase Chain Reaction).

Results: swab results were available for most participants in the trial (306/432[71%]) and in the observational (182/326 [59%]) studies. Bacterial pathogens potentially sensitive to amoxicillin (H.influenzae, M.catarrhalis, S.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.

Conclusions: 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 microbiological POC tests for children with uncomplicated LRTI in primary care rigorous validating trials are needed.

Text
1-s2.0-S1198743X22001100-main - Version of Record
Download (456kB)

More information

Accepted/In Press date: 13 February 2022
e-pub ahead of print date: 11 March 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.

Identifiers

Local EPrints ID: 456560
URI: http://eprints.soton.ac.uk/id/eprint/456560
ISSN: 1198-743X
PURE UUID: 74e46963-4dcd-4198-9847-78cdc524f8c4
ORCID for Robert C. Read: ORCID iD orcid.org/0000-0002-4297-6728
ORCID for Taeko Becque: ORCID iD orcid.org/0000-0002-0362-3794
ORCID for Nick A. Francis: ORCID iD orcid.org/0000-0001-8939-7312
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Saul Faust: ORCID iD orcid.org/0000-0003-3410-7642
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 05 May 2022 16:31
Last modified: 06 May 2022 01:57

Export record

Altmetrics

Contributors

Author: Paul Little
Author: Robert C. Read ORCID iD
Author: Taeko Becque ORCID iD
Author: Nick A. Francis ORCID iD
Author: Alastair D. Hay
Author: Beth Stuart ORCID iD
Author: Gilly O'Reilly
Author: Natalie Thompson
Author: Kerenza Hood
Author: Saul Faust ORCID iD
Author: Kay Wang
Author: Michael Moore ORCID iD
Author: Theo Verheij

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×