Broad vs. Narrow-spectrum Antibiotics: What's the Best Choice for Common Childhood Infections?

The findings:

Bigger isn’t always better, especially when it comes to combating pediatric infectious disease. Researchers conducted a study that compared the effectiveness of broad-spectrum antibiotic treatment to narrow-spectrum antibiotic treatment for common childhood acute respiratory tract infections (ARTIs). Children who received narrow-spectrum antibiotics had a higher health-related quality of life and a reduced risk of antibiotic side effects as compared to children receiving broad-spectrum antibiotics, according to data from this study.

Why it matters:

Rising antibiotic resistance in children is a health threat that pediatric clinicians can help to solve through antibiotic stewardship — ensuring that children get the appropriate antibiotic prescription for their type of infection, at the right time, for the right duration. These study results support the use of narrow-spectrum antibiotics that are active against a targeted range of bacteria that cause most ARTIs in children. Narrow-spectrum antibiotics perform equally well or better than broad-spectrum ones, which can kill off more of the “good” bacteria in your body and cause other bacteria to become resistant to those antibiotics in the future.

Who conducted the study:

Jeffrey Gerber, MD, PhD, MSCE, associate director for Inpatient Research Activities at Clinical Futures, a CHOP Research Institute Center of Emphasis, and director of the Antimicrobial Stewardship Program at CHOP, conducted the study along with colleagues at CHOP and the Larner College of Medicine, University of Vermont.

How they did it:

Researchers conducted a retrospective study of the prescribing practices of 31 primary care practices across Pennsylvania and New Jersey between January 2015 and April 2016. They analyzed data from the electronic health records of 30,000 patients between the ages of 6 months and 12 years who had been diagnosed with earaches, strep throat infections, and sinus infections. Eighty-six percent received narrow-spectrum drugs, and 14 percent received broad-spectrum drugs. In a complimentary prospective study, the researchers conducted telephone interviews with 2,472 caregivers at five days and then 14 days following an antibiotic prescription to treat their children’s respiratory infection. The study team measured adverse drug effects, additional childcare costs, lingering symptoms, missed school days, and health-related quality of life.

Quick thoughts:

“This study showed that inappropriate prescribing of antibiotics also affects families at a much more practical level, such as missed days from school and work, side effects of the drugs, and costs for extra childcare,” Dr. Gerber said. “These can be a real burden for families.”

What’s next:

Pediatric clinicians can use these study findings to support their pediatric outpatient antibiotic stewardship efforts and encourage their colleagues to prescribe narrow-spectrum antibiotics for common childhood ARTIs.

Where the study was published:

The researchers published the study in JAMA.

Where to learn more:

Read the JAMA article, see the CHOP press release, and get more information in a research brief about Clinical Futures’ comprehensive work to develop effective antibiotic stewardship strategies in pediatric outpatient settings.