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AMOXICILLIN VERSUS PLACEBO FOR ACUTE BRONCHITIS IN CHILDREN
Doctor listening to child's lungs

November 12, 2021 - Acute bronchitis is a lower respiratory tract infection marked by inflammation of the bronchi, the large airways of the lungs. Viruses cause greater than 90% of bronchitis cases, and bacteria account for less than 2%. Bronchitis is responsible for more than 10 million doctor's visits in the U.S. each year.

A study published in The Lancet randomized 432 children aged 6 months to 12 years (average age 3.2 years) with presumptive bronchitis to amoxicillin or placebo for 7 days. The primary outcome was duration of symptoms rated moderately bad or worse. At the end of the trial, there was no significant difference between the amoxicillin and placebo groups for the primary outcome (5 vs 6 days, respectively). The authors performed prespecified subgroup analyses that looked at patients with abnormal chest signs (e.g. wheeze, crackles) (N=106), sputum (N=239), fever (N=246), or shortness of breath (N=148). Results from all of these analyses also found no benefit of antibiotics. [SH review]

The overall results of this study are not surprising, but the subgroup analyses are enlightening. Parents often push for, and providers often talk themselves into prescribing antibiotics when they hear abnormal breath sounds, fever is present, and/or the patient reports shortness of breath. In this study, patients with these findings did not do better with antibiotics.

Antibiotic stewardship is important, and studies like this one help to reassure providers that withholding antibiotics in most respiratory infections is supported by evidence.

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Bronchitis
Pediatric infections