Antibiotics for bronchiolitis in children
Abstract
Background
Bronchiolitis is a serious, potentially life‐threatening respiratory illness commonly affecting babies. It is often caused by respiratory syncytial virus (RSV). Antibiotics are not recommended for bronchiolitis unless there is concern about complications such as secondary bacterial pneumonia or respiratory failure. Nevertheless, they are used at rates of 34% to 99% in uncomplicated cases.
Objectives
To evaluate the effectiveness of antibiotics for bronchiolitis.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2010, issue 4), which includes the Cochrane Acute Respiratory Infection Group's Specialised Register, and the Database of Abstracts of Reviews of Effects, MEDLINE (January 1966 to November 2010), EMBASE (1990 to December 2010) and Current Contents (2001 to December 2010).
Selection criteria
Randomised controlled trials (RCTs) comparing antibiotics to placebo in children under two years diagnosed with bronchiolitis, using clinical criteria (including respiratory distress preceded by coryzal symptoms with or without fever). Primary clinical outcomes included time to resolution of signs or symptoms (pulmonary markers included respiratory distress, wheeze, crepitations, oxygen saturation and fever). Secondary outcomes included hospital admissions, length of hospital stay, re‐admissions, complications or adverse events and radiological findings.
Data collection and analysis
Two review authors independently analysed the search results.
Main results
Five studies (543 participants) met our inclusion criteria. One study randomised 52 children to either ampicillin or placebo and found no significant difference between the two groups for length of illness. A small study (21 children) with higher risk of potential bias randomised children with proven RSV infection to clarithromycin or placebo and found clarithromycin may reduce hospital re‐admission (8% antibiotics versus 44% placebo; Fishers exact; P = 0.081). The two studies (267 children) providing adequate data for length of hospital stay showed no difference between antibiotics and control (pooled mean difference 0.34; 95% CI ‐0.71 to 1.38). Two studies randomised children to intravenous ampicillin, oral erythromycin and control and found no difference for most symptom measures. None of the trials reported deaths.
Authors' conclusions
This review found minimal evidence to support the use of antibiotics for bronchiolitis. Research to identify a possible small subgroup of patients who have complications from bronchiolitis such as respiratory failure and who may benefit from antibiotics is justified.
PICOs
Plain language summary
Antibiotics for bronchiolitis in babies
Bronchiolitis is a serious respiratory illness that often affects young babies. It is most commonly caused by respiratory syncytial virus (RSV) and is the most common reason for hospitalisation in babies under the age of six months. Babies usually present with runny nose, cough, shortness of breath and signs of respiratory distress which can become life‐threatening. Despite its viral cause, antibiotics are prescribed in 34% to 99% of cases. Prescribers may be expecting benefits from anti‐inflammatory effects attributed to some antibiotics or be concerned about secondary bacterial infection, particularly in children who are very unwell and require intensive care admission.
This systematic review found five trials (543 participants) comparing antibiotics with placebo or no antibiotics. Two of these also compared intravenous and oral antibiotics. Two trials showed that antibiotics are no better than placebo at reducing the length of illness of bronchiolitis and hospitalisation. Two more recent studies comparing antibiotics with no antibiotics found no improvement in the length of illness or hospitalisation. One smaller, poorer quality trial found benefit for antibiotics over placebo for some outcomes. Only one of the five included trials had a low risk of bias. Antibiotics may be justified in children who are very unwell and requiring intensive care admission. Antibiotics need to be used cautiously owing to the potential for side effects, cost to the patient and the community and increasing bacterial resistance to antibiotics.
