Comparative Effectiveness of Antibiotics for Respiratory Infections

Outpatient, ARTIs account for the vast majority of antibiotic exposure to children, and
roughly half of these antibiotic prescriptions are inappropriate. Although unnecessary
antibiotic prescribing for viral infections has significantly decreased, there has been a
substantial increase in prescribing of broad-spectrum antibiotics to treat ARTIs when
narrow-spectrum antibiotics are indicated. Primary care providers, patients, and caregivers
would benefit from studies assessing the implications of alternate antibiotic regimens for
these common infections. Specifically, it remains unclear if treating common ARTIs with
broad-spectrum antibiotics leads to an improvement in patient outcomes compared to treatment
with narrow-spectrum antibiotics, particularly considering the increasing threat posed by
antimicrobial resistance. Because of the lack of large comparative effectiveness studies with
patient-centered outcomes addressing this issue, professional guidelines and expert
recommendations are conflicting, and, as a result, practice patterns vary considerably.
Therefore, using patient-centered outcomes, we aim to compare narrow-spectrum and
broad-spectrum antibiotics for the treatment of common ARTIs in children. To accomplish this,
we will perform a prospective cohort study of children receiving antibiotics for ARTI across
a comprehensive pediatric healthcare network. We will conduct telephone interviews with
parent's of children who receive antibiotic treatment for an ARTI. We will assess previously
identified patient-centered outcomes included a health-related quality of life measure,
occurrence of side effects, missed school/daycare, parent missed commitments and/or required
additional childcare and symptoms were still present on day 3 after diagnosis.

Inclusion Criteria:

We included children between six months and 12 years old, diagnosed with an ARTI (acute
otitis media, acute sinusitis, Group A streptococcal [GAS] pharyngitis) using International
Classification of Diseases diagnosis codes and prescribed an antibiotic. For GAS
pharyngitis, the child also had a positive rapid streptococcal test.

Exclusion Criteria:

- Diagnosed with multiple ARTIs

- Diagnosed with another non-ARTI bacterial infection

- Prescribe antibiotics in the past 30 days

- Non-English speaking families

- If GAS pharyngitis diagnosis, age < 3 years