SYSTEMATIC REVIEW OF THE TREATMENT OF UPPER RESPIRATORY-TRACT INFECTION

Objectives-To assess the risks and benefits of antibiotic treatment in children with symptoms of upper respiratory tract infection (URTI). D esign-Quantitative systematic review of randomised trials that compare antibiotic treatment with placebo. Data sources-Twelve trials retriev ed from a systematic search (electronic databases, contact with author s, contact with drug manufacturers, reference lists); no restriction o n language. Main outcome measures-The proportion of children in whom t he clinical outcome was worse or unchanged; the proportion of children who suffered complications or progression of illness; the proportion of children who had side effects. Results-1699 children were randomise d in six trials that contributed to the meta-analysis. Six trials were not used in the meta-analysis because of different outcomes or incomp lete data. Clinical outcome was not improved by antibiotic treatment ( relative risk 1.01, 95% confidence interval (CI) 0.90 to 1.13), neithe r was the proportion of children suffering from complications or progr ession of illness (relative risk 0.71, 95% CI 0.45 to 1.12). Complicat ions 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 effects compared with placebo (relative risk 0.8, 95% CI 0.54 to 1.21). Conclusions-In view of the lack of efficacy and low complic ation rates, antibiotic treatment of children with URTI is not support ed by current evidence from randomised trials.