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Intervention Review

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Antibiotics for preventing suppurative complications from undifferentiated acute respiratory infections in children under five years of age

  1. Márcia G Alves Galvão1,
  2. Marilene Augusta Rocha Crispino Santos1,
  3. Antonio JL Alves da Cunha2,*

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 18 FEB 2014

Assessed as up-to-date: 22 MAY 2013

DOI: 10.1002/14651858.CD007880.pub2

How to Cite

Alves Galvão MG, Rocha Crispino Santos MA, Alves da Cunha AJL. Antibiotics for preventing suppurative complications from undifferentiated acute respiratory infections in children under five years of age. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD007880. DOI: 10.1002/14651858.CD007880.pub2.

Author Information

  1. 1

    Municipal Secretariat of Health, Rio de Janeiro, RJ, Brazil

  2. 2

    School of Medicine, Federal University of Rio de Janeiro, Department of Pediatrics, Rio de Janeiro, Rio de Janeiro, Brazil

*Antonio JL Alves da Cunha, Department of Pediatrics, School of Medicine, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Edificio do CCS - Bloco K - 2o. andar, Sala K49, Rio de Janeiro, Rio de Janeiro, 21941-902, Brazil.

Publication History

  1. Publication Status: New
  2. Published Online: 18 FEB 2014


This is not the most recent version of the article. View current version (29 FEB 2016)


References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Autret-Leca 2002 {published data only}
  • Autret-Leca E, Giraudeau B, Ployet MJ, Jonville-Bera A. Amoxicillin/clavulanic acid is ineffective at preventing otitis media in children with presumed viral upper respiratory infection: a randomized, double-blind equivalence, placebo-controlled trial. British Journal of Clinical Pharmacology 2002;54(6):652-6.
Heikkinen 1995 {published data only}
  • Heikkinen T, Ruuskanen O, Ziegler T, Waris M, Puhakka H. Short-term use of amoxicillin-clavulanate during upper respiratory tract infection for prevention of acute otitis media. Journal of Pediatrics 1995;126(2):313-6.
Rwalah 2011 {published data only}
  • Rwalah MM, Rashdan HAA. Short term antibiotics in children with upper respiratory tract infection. Rawal Medical Journal 2011;36(2):133-6. [: 0303-5212]
Sutrisna 1991 {published data only}

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Ackerman 1968 {published data only}
Arroll 2008 {published data only}
  • Arroll B, Kenealy T, Falloon K. Are antibiotics indicated as an initial treatment for patients with acute upper respiratory tract infections? A review. New Zealand Medical Journal 2008;121(1284):64-70.
Betend 1972 {published data only}
  • Betend B, Goddon R, David L. Therapeutic trial in a children's hospital of a new orally administered form of cephalexin. Lyon Medical 1972;228(14):205-8.
Bloomfield 2004 {published data only}
  • Bloomfield P, Dalton D, Karleka A, Kesson A, Duncan G, Isaacs D. Bacteraemia and antibiotic use in respiratory syncytial virus infections. Archives of Disease in Childhood 2004;89(4):363-7.
Bovier-Lapierre 1971 {published data only}
  • Bovier-Lapierre M, David M, Lauras B. Trial of use of a new oral antibiotic: cephalexin in granules in 59 children. Lyon Medical 1971;226(20):895-900.
Carr 1973 {published data only}
  • Carr WG. Clindamycin palmitate hydrochloride: a clinical trial in a pediatric office practice. Current Therapeutic Research, Clinical & Experimental 1973;15(9):630-40.
Castello 1981 {published data only}
  • Castello D, Sacchetti L, Brero P, Poncini L. Results of a clinical trial of the use of a methoxyamine (cefuroxime) in respiratory tract infections in children. Minerva Pediatrica 1981;33(17):881-6.
De Mattia 1986 {published data only}
  • De Mattia D, Santoro A, Grumo AR, Santoro N. Xibornol in inflammatory involvement of the upper airways in childhood. A comparative clinical investigation. Minerva Pediatrica 1986;38(21):1017-24.
De Sario 1986 {published data only}
  • De Sario PN, Bianco R, De Marco A, Gavioli F, Orecchia L, Salvadori G, et al. Miocamycin in pediatrics. Results of multicenter study in Piedmont and Valle d'Aosta. Annali dell'Ospedale Maria Vittoria di Torino 1986;29:317-28.
Easton 2010 {published data only}
  • Easton G, Saxena S. Antibiotic prescribing for upper respiratory tract infections in children: how can we improve?. London Journal of Primary Care 2010;3:37-41. [: 1757-1472]
Gordon 1974 {published data only}
  • Gordon M, Lovell S, Dugdale AE. The value of antibiotics in minor respiratory illness in children. A controlled trial. Medical Journal of Australia 1974;1(9):304-6.
Gronås 1971 {published data only}
  • Gronås HE, Hovig B. Azidocillin and ampicillin in the treatment of upper respiratory tract infections. Nordisk Medicin 1971;86(27):822-6.
Guerrier 1972 {published data only}
  • Guerrier Y. Upper respiratory tract infections in otorhinolaryngology. Annales d Oto-Laryngologie et de Chirurgie Cervico-Faciale 1972;89(1):73-8.
Gupta 1977 {published data only}
  • Gupta S, Bhushan V, Srivastava G. Therapeutic trial of chloramphenicol, eskaycillin (ampicillin) and co-trimoxazole in upper respiratory tract infections of childhood. Indian Pediatrics 1977;14(5):391-3.
Hardy 1956 {published data only}
  • Hardy L, Traisman H. Antibiotics and chemotherapeutic agents in the treatment of uncomplicated respiratory infections in children; a controlled study. Journal of Pediatrics 1956;48(2):146-56.
He 2006 {published data only}
  • He BB, Chen F. Clinical efficacy of cefixime in the treatment of children with respiratory tract infection. Chinese Journal of Antibiotics 2006;31(9):571-2, 575.
Henness 1982 {published data only}
Kundu 1976 {published data only}
  • Kundu SC. Therapeutic usefulness of combination therapy with oral penicillin G and trisulfapyrimidine in the treatment of acute upper respiratory tract infections. Journal of the Indian Medical Association 1976;67(11):252-2.
Lake 1971 {published data only}
Lexomboon 1971 {published data only}
  • Lexomboon U, Duangmani C, Kusalasai V, Sunakorn P, Olson LC, Noyes HE. Evaluation of orally administered antibiotics for treatment of upper respiratory infections in Thai children. Journal of Pediatrics 1971;78(5):772-8.
Limson 1972 {published data only}
  • Limson BM, Siasoco RE, Dial FP. A new cephalosporin derivative, cephradine (TM), in the treatment of acute infective diseases. Current Therapeutic Research, Clinical & Experimental 1972;14(3):101-6.
Lines 1973 {published data only}
  • Lines DR, Vimpani GV, Pearson CC. The use of 7-chlorolincomycin in the treatment of childhood respiratory disease. Medical Journal of Australia 1973;1(9):439-41.
Little 1997 {published data only}
  • Little P, Gould C, Williamson I, Warner G, Gantley M, Kinmonth AL. Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics.[see comment]. BMJ 1997;315(7104):350-2.
Maeda 1999 {published data only}
Masbernard 1979 {published data only}
  • Masbernard A, Salord JC. Therapy with cefaclor: analysis of infections in 189 French patients. Postgraduate Medical Journal 1979;55(Suppl 4):72-6.
McGuinness 1986 {published data only}
Newell 1970 {published data only}
Oggero 1985 {published data only}
  • Oggero R, Pugliaro G, Galvagno G, Frigerio M. Antibacterial efficacy of a new chemotherapeutic agent in acute infections of the upper respiratory tract in childhood. Controlled clinical trial of xibornol and josamycin. Minerva Pediatrica 1985;37(10):419-24.
Pan 2000 {published data only}
  • Pan Q, Ornstein S, Gross AJ, Hueston WJ, Jenkins RG, Mainous Iii AG, et al. Antibiotics and return visits for respiratory illness: a comparison of pooled versus hierarchical statistical methods. American Journal of the Medical Sciences 2000;319(6):360-5.
Price 1975 {published data only}
  • Price JD, Harding JW. Amoxycillin in the treatment of respiratory tract infection in children. British Journal of Clinical Practice 1975;29(8):203-6.
Reinert 1991 {published data only}
  • Reinert P, Narcy P, Paliwoda A, Rouffiac E. Evaluation of tixocortol pivalate-neomycin combination versus ++a placebo excipient in acute rhinopharyngitis in children. Annales de Pediatrie 1991;38(7):503-8.
Rentsch 1980 {published data only}
  • Rentsch M. The treatment with minocyciline (Minocin) in daily pediatric practice (author's transl). Schweizerische Rundschau fur Medizin Praxis 1980;69(47):1756-9.
Roper 1970 {published data only}
  • Roper DJ, Harding JW. General practice trial of flucloxacillin in common respiratory tract infections. British Journal of Clinical Practice 1970;24(10):419-21.
Taylor 1977 {published data only}
  • Taylor B, Abbott GD, Kerr MM, Fergusson DM. Amoxycillin and co trimoxazole in presumed viral respiratory infections of childhood: placebo controlled trial. British Medical Journal 1977;2(6086):552-4.
Todd 1981 {published data only}
  • Todd J, Todd N, Damato J, Todd W. Diagnosis and treatment of purulent nasopharyngitis - a double-blind, two-drug evaluation. Pediatric Research 1981;15:623.
Varricchio 2006 {published data only}
  • Varricchio A, Tricarico D, De Lucia A, Utili R, Tripodi MF, Del Giudice M, et al. Inhaled tobramycin in children with acute bacterial rhinopharyngitis. International Journal of Immunopathology & Pharmacology 2006;19(1):131-40.
Varricchio 2008 {published data only}
  • Varricchio A, Capasso M, Di Gioacchino M, Ciprandi G. Inhaled thiamphenicol and acetylcysteine in children with acute bacterial rhinopharyngitis. International Journal of Immunopathology & Pharmacology 2008;21(3):625-9.
Windorfer 1980 {published data only}
  • Windorfer A, Maier Lenz H, Bauer P, Alterthum K. Cefadroxil in infections of the upper respiratory tract in pediatrics. Infection 1980;8(Suppl 5):610-3.
Zwart 2003 {published data only}
Zwart 2004 {published data only}
  • Zwart S, Rovers MM, de Melker RA, Lindbaek M. Penicillin V did not shorten symptoms in children with sore throat. Evidence-Based Medicine 2004;9:77.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Abdel-Aziz 2010
  • Abdel-Aziz, El-Hoshy. Acute mastoiditis: a one year study in the pediatric hospital of Cairo university. BMC Ear, Nose and Throat Disorders 2010;10:1-6.
Akkerman 2005
  • Akkerman AE, Kuyvenhoven MM, van der Wouden JC, Verheij TJ. Determinants of antibiotic overprescribing in respiratory tract infections in general practice. Journal of Antimicrobial Chemotherapy 2005;56:930-6.
Altamimi 2012
Arason 2010
  • Arason VA, Sigurdsson JA. The problems of antibiotic overuse. Scandinavian Journal of Primary Health Care 2010; Vol. 28:65-6.
Arroll 2010
  • Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews 2010, Issue 2. [DOI: 10.1002/14651858.CD000247.pub2]
Baron 2013
  • Baron EJ, Miller JM, Weinstein MP, Richter SS, Gilligan PH, Thomson RB Jr, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clinical Infectious Diseases 2013;57:485-8.
Benguigui 2003
  • Benguigui Y. Acute respiratory infections control in the context of the IMCI strategy in the Americas. Revista Brasileira de Saúde Materno Infantil 2003;3(1):25-6.
Chung 2007
  • Chung A, Perera R, Brueggemann AB, Elamin AE, Harnden A, Mayon-White R, et al. Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study. BMJ 2007;335:429.
Coco 2009
Costelloe 2010
  • Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2012;18(340):2096.
Dagan 2008
Del Mar 2012
  • Del Mar C,  Glasziou P,  Lowe JB,  van Driel ML,  Hoffmann T,  Beller E. Addressing antibiotic resistance - focusing on acute respiratory infections in primary care. Australian Family Physician 2012;41(11):839-40.
Doan 2012
Dowell 1998
  • Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz B. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics 1998;101:163-5.
Editorial 2009
  • Editorial. Urgently needed: new antibiotics. Lancet 2009;374:1868.
Emmelin 2007
Fahey 1998a
Fahey 1998b
Farha 2005
  • Farha T, Thomson AH. The burden of pneumonia in children in the developed world. Paediatric Respiratory Reviews 2005;6(2):76-82.
Garenne 1992
  • Garenne FE, Ronsmans C, Campbell H. The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries. World Health Statistics Quarterly 1992;45:180-91.
Gjelstad 2013
  • Gjelstad S, Høye S, Straand J, Brekke M, Dalen I, Lindbæk M. Improving antibiotic prescribing in acute respiratory tract infections: cluster randomised trial from Norwegian general practice (prescription peer academic detailing (Rx-PAD) study). BMJ 2013;347:f4403.
Hay 2002
  • Hay AD,  Wilson AD. The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review. British Journal of General Practice 2002;52:401-9.
Higgins 2011
  • Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available from Chichester, UK: John Wiley & Sons, Ltd, 2011.
Hope-Simpson 1973
Howie 1971
  • Howie JG, Richardson IM, Gill G, Durno D. Respiratory illness and antibiotic use in general practice. Journal of the Royal College of General Practitioners 1971;21:657-63.
Jansen 2006
  • Jansen A, Sanders E, Schilder A, Hoes A, de Jong V, Hak E. Primary care management of respiratory tract infections in Dutch preschool children. Scandinavian Journal of Primary Health Care 2006;24(4):231-6.
Kabra 2013
Klein 2000
Kumar 2003
Kumar 2009
  • Kumar A,  Ellis P,  Arabi Y,  Roberts D,  Light B,  Parrillo JE,  et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 2009;136:1237-48.
Kusel 2007
Kutty 2011
  • Kutty N. Treating children without antibiotics in primary healthcare. Oman Medical Journal 2011;26:303-5.
Larsson 2005
  • Larsson M, Falkenberg T, Dardashti A, Ekman T, Törnquist S, Kim Chuc N, et al. Overprescribing of antibiotics to children in rural Vietnam. Scandinavian Journal of Infectious Diseases 2005;37:442-8.
Lefebvre 2011
  • Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available from 2011.
Little 2002
  • Little P, Watson L, Morgan S, Williamson I. Antibiotic prescribing and admissions with major suppurative complications of respiratory tract infections: a data linkage study. British Journal of General Practice 2002;52:187-93.
Majeed 2004
Margolis 1998
McCaig 1995
Nascimento-Carvalho 2006
  • Nascimento-Carvalho CM. Outpatient antibiotic therapy as a predisposing factor for bacterial resistance: a rational approach to airway infections [Antibioticoterapia ambulatorial como fator de indução da resistência bacteriana: uma abordagem racional para as infecções de vias aéreas]. Jornal de Pediatria 2006;Suppl 82:146-52.
Petersen 2007
  • Petersen I, Johnson AM, Islam A, Duckworth G, Livermore DM, Hayward A. Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ 2007;335:982.
Posfay-Barbe 2008
RevMan 2012
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Rudan 2004
  • Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H on behalf of WHO Child Health Epidemiology Reference Group. Global estimate of incidence of clinical pneumonia among children under five years of age. Bulletin of the World Health Organization 2004;82:12.
Rudan 2008
Schraff 2001
Schuetz 2012
Sharland 2005
  • Sharland M, Kendall H, Yeates D, Randall A, Hughes G, Glasziou P, et al. Antibiotic prescribing in general practice and hospital admissions for peritonsillar abscess, mastoiditis, and rheumatic fever in children: time trend analysis. BMJ 2005;331:328-9.
Spinks 2011
Spurling 2013
Tan 2008
  • Tan T, Little P, Stokes T, on behalf of the Guideline Development Group. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ 2008;337:a437.
Thompson 2008
  • Thompson PL, Gilbert RE, Long PF, Saxena S, Sharland M, Wong IC. Has UK guidance affected general practitioner antibiotic prescribing for otitis media in children?. Journal of Public Health 2008;30:479-86.
Thompson 2009
  • Thompson PL, Spyridis N, Sharland M, Gilbert RE, Saxena S, Long PF, et al. Changes in clinical indications for community antibiotic prescribing for children in the UK from 1996-2006: will the new NICE prescribing guidance on upper respiratory tract infection be ignored?. Archives of Disease in Childhood 2009;94(5):337-40.
van Balen 2004
  • van Balen JA, Verheij TJ, Pijnenborg L, Assendelft WJ, Nederlands Huisartsen Genootschap. Summary of the practice guideline 'Acute cough' from the Dutch College of General Practitioners. Nederlands Tijdschrift voor Geneeskunde 2004;148:725-8.
van Driel 2013
Venekamp 2013
  • Venekamp RP, Sanders S, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD000219.pub2]
Vergison 2010
WHO 2007
  • World Health Organization. International Classification of Diseases (ICD). 2007 (accessed 20 November 2007).
WHO 2012
  • World Health Organization. Recommendations for management of common childhood conditions. Evidence for technical update of pocket book recommendations. World Health Organization, 2012.