Comparing broad- and narrow-Spectrum antibiotics for children with ear, sinus, and throat infections
For the comparative effectiveness objective, narrow-spectrum antibiotics were associated with a higher health-related QOL score (PedsQL score difference: stratified approach 1.6; 95% CI, 0.5-2.8; propensity-score matched approach: 1.4; 95% CI, 0.4-2.4). Compared with narrow-spectrum antibiotics, bro...
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| Format: | eBook |
| Language: | English |
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Washington (DC)
Patient-Centered Outcomes Research Institute (PCORI)
2018, 2018
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | For the comparative effectiveness objective, narrow-spectrum antibiotics were associated with a higher health-related QOL score (PedsQL score difference: stratified approach 1.6; 95% CI, 0.5-2.8; propensity-score matched approach: 1.4; 95% CI, 0.4-2.4). Compared with narrow-spectrum antibiotics, broad-spectrum antibiotics were not associated with improved outcomes on any of the secondary patient-centered outcomes but were associated with increased rates of adverse drug effects as reported by parents (raw %: narrow 25.2%, broad 35.5%; stratified approach RD [risk difference] = -11.4%; 95% CI, -17.0% to -5.8%; propensity-score approach RD = -11.4%; 95% CI, -16.4 to -6.4). CONCLUSIONS: Treatment with broad-spectrum antibiotics was not better than narrow-spectrum antibiotics for children with ARTIs. Receipt of broad-spectrum antibiotics was associated with higher rates of adverse drug effects. Given current national prescribing patterns, outpatient antimicrobial stewardship efforts should focus on antibiotic selection for the most common childhood ARTIs BACKGROUND: Outpatient acute respiratory tract infections (ARTIs), including acute otitis media, streptococcal pharyngitis , and acute sinusitis, account for the vast majority of antibiotic exposure in children, and much of it is inappropriate. Broad-spectrum antibiotic prescribing for ARTIs has increased. It remains unclear if treating ARTIs with broad-spectrum antibiotics compared with treatment with narrow-spectrum agents leads to improved outcomes. Primary care providers, patients, and caregivers would benefit from studies assessing the implications of alternate antibiotic regimens for these common infections. OBJECTIVES: (1) Identify the outcomes most important to parents' and children regarding the treatment of ARTIs with antibiotics, and (2) compare the effectiveness of narrow- and broadspectrum antibiotic therapy for ARTIs on patient- and clinician-centered outcomes. METHODS: The study was performed in a network of 31 pediatric primary care practices. To assess clinician-centered outcomes, we conducted a retrospective observational cohort study, including all children treated with antibiotics for ARTIs in 2015, using electronic health record data. To control for confounding, 2 analytic approaches--a stratified analysis and a propensity score matched analysis--were implemented. RESULTS: To achieve the first objective, we interviewed 109 parents and 24 children. Parents identified 4 important outcomes related to antibiotic use for their child's ARTI: disrupted sleep, missed school and parent work, child suffering, and speed of symptom resolution. Parents confirmed the importance of diarrhea and gastrointestinal distress and having an allergic reaction, outcomes we had previously identified as important. For children, missing school, disrupted sleep, and speed of symptom resolution were outcomes of concern. To identify patient-centered outcomes, we conducted semistructured interviews with caregivers of children attending acute office visits and brief interviews with children, which were analyzed by 2 coders using a modified grounded theory approach. To compare the effectiveness of antibiotics by spectrum, we performed 2 studies. First, to assess patient-centered outcomes, we conducted a prospective observational cohort study. Between January 2015 and April 2016, a stratified sample of caregivers of children treated with antibiotics for ARTIs was assessed according to the previously identified patient-centered outcomes from telephone interviews at 5 to 10 days and at 14 to 20 days postdiagnosis. The primary patient-centered outcome was health-related quality of life (QOL) as determined by the Pediatric Quality of Life Inventory (PedsQL) total score (measured at first interview). |
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| Physical Description: | 1 PDF file (96 pages) illustrations |