Antibiotics for persistent cough or wheeze following acute bronchiolitis in children

Gabrielle B. McCallum, Erin J. Plumb, Peter S. Morris, Anne B. Chang

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    Abstract

    Background: Bronchiolitis is a common acute respiratory conditionwith high prevalenceworldwide.This clinically diagnosed syndrome ismanifested by tachypnoea (rapid breathing), with crackles or wheeze in young children. In the acute phase of bronchiolitis (≤ 14 days), antibiotics are not routinely prescribed unless the illness is severe or a secondary bacterial infection is suspected. Although bronchiolitis is usually self-limiting, some young children continue to have protracted symptoms (e.g. cough and wheezing) beyond the acute phase and often re-present to secondary care.

    Objectives: To compare the effectiveness of antibiotics versus controls (placebo or no treatment) for reducing or treating persistent respiratory symptoms following acute bronchiolitis within six months of acute illness.

    Search methods: We searched the following databases: the Cochrane Airways Group Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE (Ovid), Embase (Ovid), theWorld Health Organization (WHO) trial portal, the Australian and New Zealand Clinical Trials Registry, and ClinicalTrials.gov, up to 26 August 2016.

    Selection criteria: We included randomised controlled trials (RCTs) comparing antibiotics versus controls (placebo or no treatment) given in the postacute phase of bronchiolitis (> 14 days) for children younger than two years with a diagnosis of bronchiolitis.

    Data collection and analysis: Two review authors independently assessed studies against predefined criteria, and selected, extracted, and assessed data for inclusion. We contacted trial authors for further information.

    Main results: In this review update, we added one study with 219 children. A total of two RCTs with 249 children (n = 240 completed) were eligible for inclusion in this review. Both studies contributed to our primary and secondary outcomes, but we assessed the quality of evidence for our three primary outcomes as low, owing to the small numbers of studies and participants; and high attrition in one of the studies. Data show no significant differences between treatment groups for our primary outcomes: proportion of children (n = 249) who had persistent symptoms at follow-up (odds ratio (OR) 0.69, 95%confidence interval (CI) 0.37 to 1.28; fixed-effectmodel); and number of children (n = 240) rehospitalised with respiratory illness within six months (OR 0.54, 95%CI 0.05 to 6.21; random-effects model). We were unable to analyse exacerbation rate because studies used different methods to report this information. Data showed no significant differences between treatment groups for our secondary outcome: proportion of children (n = 240) with wheeze at six months (OR 0.47, 95% CI 0.06 to 3.95; random-effects model). One study reported bacterial resistance, but only at 48 hours (thus with limited applicability for this review). Another study reported adverse events from which all children recovered and remained in the study.

    Authors' conclusions: Current evidence is insufficient to inform whether antibiotics should be used to treat or prevent persistent respiratory symptoms in the post-acute bronchiolitis phase. Future RCTs are needed to evaluate the efficacy of antibiotics for reducing persistent respiratory symptoms. This is particularly important in populations with high acute and post-acute bronchiolitis morbidity (e.g. indigenous populations in Australia, New Zealand, and the USA).

    Original languageEnglish
    Article numberCD009834
    Pages (from-to)1-32
    Number of pages32
    JournalCochrane Database of Systematic Reviews
    Volume2017
    Issue number8
    DOIs
    Publication statusPublished - 22 Aug 2017

    Fingerprint

    Bronchiolitis
    Cough
    Anti-Bacterial Agents
    Randomized Controlled Trials
    Odds Ratio
    Respiratory Sounds
    Confidence Intervals
    New Zealand
    Placebos
    Tachypnea
    Secondary Care
    Therapeutics
    Coinfection
    Population Groups
    Bacterial Infections
    MEDLINE
    Patient Selection
    Registries
    Respiration
    Clinical Trials

    Cite this

    @article{04661030219c4f72ac86d76bfdf4b3bc,
    title = "Antibiotics for persistent cough or wheeze following acute bronchiolitis in children",
    abstract = "Background: Bronchiolitis is a common acute respiratory conditionwith high prevalenceworldwide.This clinically diagnosed syndrome ismanifested by tachypnoea (rapid breathing), with crackles or wheeze in young children. In the acute phase of bronchiolitis (≤ 14 days), antibiotics are not routinely prescribed unless the illness is severe or a secondary bacterial infection is suspected. Although bronchiolitis is usually self-limiting, some young children continue to have protracted symptoms (e.g. cough and wheezing) beyond the acute phase and often re-present to secondary care. Objectives: To compare the effectiveness of antibiotics versus controls (placebo or no treatment) for reducing or treating persistent respiratory symptoms following acute bronchiolitis within six months of acute illness. Search methods: We searched the following databases: the Cochrane Airways Group Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE (Ovid), Embase (Ovid), theWorld Health Organization (WHO) trial portal, the Australian and New Zealand Clinical Trials Registry, and ClinicalTrials.gov, up to 26 August 2016. Selection criteria: We included randomised controlled trials (RCTs) comparing antibiotics versus controls (placebo or no treatment) given in the postacute phase of bronchiolitis (> 14 days) for children younger than two years with a diagnosis of bronchiolitis. Data collection and analysis: Two review authors independently assessed studies against predefined criteria, and selected, extracted, and assessed data for inclusion. We contacted trial authors for further information. Main results: In this review update, we added one study with 219 children. A total of two RCTs with 249 children (n = 240 completed) were eligible for inclusion in this review. Both studies contributed to our primary and secondary outcomes, but we assessed the quality of evidence for our three primary outcomes as low, owing to the small numbers of studies and participants; and high attrition in one of the studies. Data show no significant differences between treatment groups for our primary outcomes: proportion of children (n = 249) who had persistent symptoms at follow-up (odds ratio (OR) 0.69, 95{\%}confidence interval (CI) 0.37 to 1.28; fixed-effectmodel); and number of children (n = 240) rehospitalised with respiratory illness within six months (OR 0.54, 95{\%}CI 0.05 to 6.21; random-effects model). We were unable to analyse exacerbation rate because studies used different methods to report this information. Data showed no significant differences between treatment groups for our secondary outcome: proportion of children (n = 240) with wheeze at six months (OR 0.47, 95{\%} CI 0.06 to 3.95; random-effects model). One study reported bacterial resistance, but only at 48 hours (thus with limited applicability for this review). Another study reported adverse events from which all children recovered and remained in the study. Authors' conclusions: Current evidence is insufficient to inform whether antibiotics should be used to treat or prevent persistent respiratory symptoms in the post-acute bronchiolitis phase. Future RCTs are needed to evaluate the efficacy of antibiotics for reducing persistent respiratory symptoms. This is particularly important in populations with high acute and post-acute bronchiolitis morbidity (e.g. indigenous populations in Australia, New Zealand, and the USA).",
    author = "McCallum, {Gabrielle B.} and Plumb, {Erin J.} and Morris, {Peter S.} and Chang, {Anne B.}",
    year = "2017",
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    doi = "10.1002/14651858.CD009834.pub3",
    language = "English",
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    Antibiotics for persistent cough or wheeze following acute bronchiolitis in children. / McCallum, Gabrielle B.; Plumb, Erin J.; Morris, Peter S.; Chang, Anne B.

    In: Cochrane Database of Systematic Reviews, Vol. 2017, No. 8, CD009834, 22.08.2017, p. 1-32.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Antibiotics for persistent cough or wheeze following acute bronchiolitis in children

    AU - McCallum, Gabrielle B.

    AU - Plumb, Erin J.

    AU - Morris, Peter S.

    AU - Chang, Anne B.

    PY - 2017/8/22

    Y1 - 2017/8/22

    N2 - Background: Bronchiolitis is a common acute respiratory conditionwith high prevalenceworldwide.This clinically diagnosed syndrome ismanifested by tachypnoea (rapid breathing), with crackles or wheeze in young children. In the acute phase of bronchiolitis (≤ 14 days), antibiotics are not routinely prescribed unless the illness is severe or a secondary bacterial infection is suspected. Although bronchiolitis is usually self-limiting, some young children continue to have protracted symptoms (e.g. cough and wheezing) beyond the acute phase and often re-present to secondary care. Objectives: To compare the effectiveness of antibiotics versus controls (placebo or no treatment) for reducing or treating persistent respiratory symptoms following acute bronchiolitis within six months of acute illness. Search methods: We searched the following databases: the Cochrane Airways Group Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE (Ovid), Embase (Ovid), theWorld Health Organization (WHO) trial portal, the Australian and New Zealand Clinical Trials Registry, and ClinicalTrials.gov, up to 26 August 2016. Selection criteria: We included randomised controlled trials (RCTs) comparing antibiotics versus controls (placebo or no treatment) given in the postacute phase of bronchiolitis (> 14 days) for children younger than two years with a diagnosis of bronchiolitis. Data collection and analysis: Two review authors independently assessed studies against predefined criteria, and selected, extracted, and assessed data for inclusion. We contacted trial authors for further information. Main results: In this review update, we added one study with 219 children. A total of two RCTs with 249 children (n = 240 completed) were eligible for inclusion in this review. Both studies contributed to our primary and secondary outcomes, but we assessed the quality of evidence for our three primary outcomes as low, owing to the small numbers of studies and participants; and high attrition in one of the studies. Data show no significant differences between treatment groups for our primary outcomes: proportion of children (n = 249) who had persistent symptoms at follow-up (odds ratio (OR) 0.69, 95%confidence interval (CI) 0.37 to 1.28; fixed-effectmodel); and number of children (n = 240) rehospitalised with respiratory illness within six months (OR 0.54, 95%CI 0.05 to 6.21; random-effects model). We were unable to analyse exacerbation rate because studies used different methods to report this information. Data showed no significant differences between treatment groups for our secondary outcome: proportion of children (n = 240) with wheeze at six months (OR 0.47, 95% CI 0.06 to 3.95; random-effects model). One study reported bacterial resistance, but only at 48 hours (thus with limited applicability for this review). Another study reported adverse events from which all children recovered and remained in the study. Authors' conclusions: Current evidence is insufficient to inform whether antibiotics should be used to treat or prevent persistent respiratory symptoms in the post-acute bronchiolitis phase. Future RCTs are needed to evaluate the efficacy of antibiotics for reducing persistent respiratory symptoms. This is particularly important in populations with high acute and post-acute bronchiolitis morbidity (e.g. indigenous populations in Australia, New Zealand, and the USA).

    AB - Background: Bronchiolitis is a common acute respiratory conditionwith high prevalenceworldwide.This clinically diagnosed syndrome ismanifested by tachypnoea (rapid breathing), with crackles or wheeze in young children. In the acute phase of bronchiolitis (≤ 14 days), antibiotics are not routinely prescribed unless the illness is severe or a secondary bacterial infection is suspected. Although bronchiolitis is usually self-limiting, some young children continue to have protracted symptoms (e.g. cough and wheezing) beyond the acute phase and often re-present to secondary care. Objectives: To compare the effectiveness of antibiotics versus controls (placebo or no treatment) for reducing or treating persistent respiratory symptoms following acute bronchiolitis within six months of acute illness. Search methods: We searched the following databases: the Cochrane Airways Group Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE (Ovid), Embase (Ovid), theWorld Health Organization (WHO) trial portal, the Australian and New Zealand Clinical Trials Registry, and ClinicalTrials.gov, up to 26 August 2016. Selection criteria: We included randomised controlled trials (RCTs) comparing antibiotics versus controls (placebo or no treatment) given in the postacute phase of bronchiolitis (> 14 days) for children younger than two years with a diagnosis of bronchiolitis. Data collection and analysis: Two review authors independently assessed studies against predefined criteria, and selected, extracted, and assessed data for inclusion. We contacted trial authors for further information. Main results: In this review update, we added one study with 219 children. A total of two RCTs with 249 children (n = 240 completed) were eligible for inclusion in this review. Both studies contributed to our primary and secondary outcomes, but we assessed the quality of evidence for our three primary outcomes as low, owing to the small numbers of studies and participants; and high attrition in one of the studies. Data show no significant differences between treatment groups for our primary outcomes: proportion of children (n = 249) who had persistent symptoms at follow-up (odds ratio (OR) 0.69, 95%confidence interval (CI) 0.37 to 1.28; fixed-effectmodel); and number of children (n = 240) rehospitalised with respiratory illness within six months (OR 0.54, 95%CI 0.05 to 6.21; random-effects model). We were unable to analyse exacerbation rate because studies used different methods to report this information. Data showed no significant differences between treatment groups for our secondary outcome: proportion of children (n = 240) with wheeze at six months (OR 0.47, 95% CI 0.06 to 3.95; random-effects model). One study reported bacterial resistance, but only at 48 hours (thus with limited applicability for this review). Another study reported adverse events from which all children recovered and remained in the study. Authors' conclusions: Current evidence is insufficient to inform whether antibiotics should be used to treat or prevent persistent respiratory symptoms in the post-acute bronchiolitis phase. Future RCTs are needed to evaluate the efficacy of antibiotics for reducing persistent respiratory symptoms. This is particularly important in populations with high acute and post-acute bronchiolitis morbidity (e.g. indigenous populations in Australia, New Zealand, and the USA).

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