Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK.
Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK.
Br J Gen Pract. 2023 Feb 23;73(728):e156-e163. doi: 10.3399/BJGP.2022.0239. Print 2023 Mar.
Antibiotics are commonly prescribed for children with chest infections but there is little randomised evidence and trials commonly recruit selected populations, which undermines their applicability.
To document the effectiveness of antibiotics for chest infections in children.
This was a prospective cohort study with nested trial in primary care.
Children aged 1-12 years presenting with uncomplicated lower respiratory tract infections were included in the cohort. Children were either randomised to receive amoxicillin 50 mg/kg per day for 7 days or placebo, or participated in a parallel observational study, where propensity scores controlled for confounding by indication. The outcomes were duration of symptoms rated moderately bad or worse (primary outcome) and illness progression requiring hospital assessment.
A total of 764 children participated (438 trial, 326 observational), and children were more unwell than in previous cohorts (more sputum, fever, shortness of breath). Children had been unwell for a median of 5-6 days, and symptoms rated moderately bad or worse lasted another 6 days when no antibiotics were given.With antibiotics there was a non-significant reduction of approximately 1 day in duration of symptoms rated moderately bad or worse for the whole cohort (hazard ratio [HR] 1.16, 95% confidence interval [CI] = 0.95 to 1.41), similar to the trial alone (HR 1.13, 95% CI = 0.90 to 1.43). The effect of antibiotic treatment on secondary outcomes was also non-significant.
Antibiotics for uncomplicated chest infections, even in a sample of more unwell children, are unlikely to be clinically very effective.
抗生素常用于治疗儿童胸部感染，但随机对照试验的证据很少，且试验通常招募特定人群，这削弱了其适用性。
记录抗生素治疗儿童胸部感染的效果。
这是一项在初级保健中进行的前瞻性队列研究，嵌套了试验。
年龄在 1-12 岁的患有单纯性下呼吸道感染的儿童被纳入队列。儿童随机接受每天 50 毫克/公斤的阿莫西林治疗 7 天或安慰剂，或参加平行的观察性研究，通过倾向评分控制指示性混杂因素。主要结局是症状持续时间评为中度差或更差（主要结局）和需要住院评估的疾病进展。
共有 764 名儿童参与（438 名试验，326 名观察），且儿童的病情比以往的队列更为严重（更多的痰、发热、呼吸急促）。儿童的不适症状持续了中位数为 5-6 天，在没有使用抗生素的情况下，症状评为中度差或更差的时间又持续了 6 天。对于整个队列，使用抗生素可使症状持续时间评为中度差或更差的时间非显著减少约 1 天（风险比 [HR] 1.16，95%置信区间 [CI] = 0.95 至 1.41），与仅进行试验时相似（HR 1.13，95% CI = 0.90 至 1.43）。抗生素治疗对次要结局的影响也不显著。
对于单纯性胸部感染，即使在病情更为严重的儿童样本中，抗生素也不太可能具有明显的临床效果。
