Systematic review of the treatment of upper respiratory tract infection

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Abstract
OBJECTIVES To assess the risks and benefits of antibiotic treatment in children with symptoms of upper respiratory tract infection (URTI). DESIGN Quantitative systematic review of randomised trials that compare antibiotic treatment with placebo. DATA SOURCES Twelve trials retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists); no restriction on language. MAIN OUTCOME MEASURES The proportion of children in whom the 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 randomised in six trials that contributed to the meta-analysis. Six trials were not used in the meta-analysis because of different outcomes or incomplete data. Clinical outcome was not improved by antibiotic treatment (relative risk 1.01, 95% confidence interval (CI) 0.90 to 1.13), neither was the proportion of children suffering from complications or progression of illness (relative risk 0.71, 95% CI 0.45 to 1.12). Complications 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 complication rates, antibiotic treatment of children with URTI is not supported by current evidence from randomised trials. Antibiotic treatment did not alter clinical outcome or reduce complication rates in children with upper respiratory tract infections Side effects were similar in antibiotic treatment and placebo groups Complications from upper respiratory tract infections are low (2–15%) Larger trials are needed to establish whether antibiotic treatment reduces complications in children with upper respiratory tract infections