Treatment Outcomes of the Uncomplicated Upper Respiratory Tract Infection and Acute Diarrhea in Preschool Children Comparing Those with and without Antibiotic Prescription.

BACKGROUND

Upper respiratory tract infection (URI) and acute diarrhea are the two most common reasons for ambulatory visits among young children. Unnecessary use of antibiotics to treat such conditions pose significant financial burden and can result in untoward side effects as well as risk of antimicrobial resistance. On the other hand, inadequate antibiotic treatment in certain cases may increase the risk of suppurative complications and/or invasive infection in this population.

OBJECTIVE

To compare the treatment outcomes between those with and without antibiotic treatment for the uncomplicated upper respiratory tract infection and acute diarrhea in young children.

METHODS

A prospective observational study was conducted in two groups of previously healthy children presenting with acute uncomplicated URI (aged 2 to 5 years) or acute diarrhea (aged 6 months to 5 years). On initial enrolment date, patients were treated by a pediatrician who was not a member of the study investigators. The decision for antibiotic prescription was based entirely on attending physicians' discretion. Data regarding clinical presentations, diagnosis, treatment options, and reasons for antibiotic prescription (if any) were collected. Follow-up phone interviews were conducted on day 3 of enrolment to evaluate treatment outcomes.

RESULTS

Two hundred nine cases with symptoms compatible with acute URI, and/or 199 cases with acute diarrhea were enrolled between August and November 2013. Antibiotic prescription rates for URI and diarrhea groups were 30.2% and 13.6%, respectively. Among children presenting with URI symptoms, 80.4% (n = 168) were classified as having upper respiratory tract infection e.g., common cold, acute sinusitis, pharyngitis whereas the other 19.6% were diagnosed with other conditions e.g., lower respiratory tract infection, pneumonia, viral exanthema after evaluation by a pediatrician. Overall improvement rates on day 3 were 92.3% and 86.9%for uncomplicated URIand diarrhea group, respectively. Among URI group, parental satisfaction rates were 100% and 96.6% in those received and did not receive antibiotic, respectively (p = 0.188), whereas in the diarrhea group, there were 100% and 92.7, (p = 0.35), respectively. Univariate analyses indicated that the crude odds ratios (OR) and 95% confidence intervals (CI) of treatment failure comparing those with and without antibiotics were 0.5 (0.2, 1.7) and 1.5 (0.6, 3.7) for URI and diarrhea, respectively. Logistic regression analyses indicated that antibiotic treatment was not significantly associated with better treatment outcomes for both URI and diarrhea cases i.e., adjusted ORs and 95% CI of antibiotic for requirement of additional treatment were 1.06 (0.14, 8.15) for URI cases. Further adjusted OR and 95% CI of antibiotic for treatment failure was 0.8 (0.2, 2.9) for acute diarrhea cases.

CONCLUSIONS

Antibiotic did not appear to provide clinical benefit in the management of uncomplicated URI and/or acute diarrhea among previously healthy young children.