Excerpts from: Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD000247. DOI: 10.1002/14651858.CD000247.pub3.
Eco-paediatrics is an occasional feature in Evidence-Based Child Health: A Cochrane Review Journal. Our goal is to contribute to the worldwide discussion on reducing waste in health care. In each instalment, we will select a recent Cochrane review highlighting a practice, still in use, which the available evidence tells us should be discontinued.
A common cold is a self-limiting viral infection that is experienced over and again by the entire population.
Antibiotics hasten resolution of the bacterial complications of the common cold, but have no direct effect on uncomplicated colds.
What should we do in practice?
There is no evidence of benefit from antibiotics for improving symptoms of the common cold in children or adults. The available evidence shows that antibiotics cause significant adverse effects. Overuse of antibiotics eventually leads to resistance, either for the individual who takes the antibiotics or at the population level.
What do the guidelines suggest?
|American Academy of Pediatrics (1)||Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis). Although overall antibiotic prescription rates for children have fallen, they still remain alarmingly high. Unnecessary medication use for viral respiratory illnesses can lead to antibiotic resistance and contributes to higher health-care costs and the risk of adverse events.|
|National Institute for Health and Care Excellence (2)||A ‘no antibiotic prescribing strategy’ or a ‘delayed antibiotic prescribing strategy’ should be agreed for patients with common cold. When the no antibiotic prescribing strategy is adopted, patients should be offered: reassurance that antibiotics are not needed immediately because they are likely to make little difference to symptoms and may have side effects, for example, diarrhoea, vomiting and rash; and, a clinical review if the condition worsens or becomes prolonged.|
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Commentary by J. Robinson
Every clinician on the planet knows that antibiotics are not useful and are potentially harmful for viral respiratory tract infections. However, the difficult part is sorting out when such an infection is complicated by acute otitis media, sinusitis or secondary bacterial pneumonia; there is substantial overlap of the clinical, laboratory and radiographic features of viral and bacterial infections. When seeing children with suspected nonsevere otitis media or sinusitis, the following three pieces of information should encourage clinicians to put away their pen rather than writing a prescription for antibiotics:
Although antibiotics sometimes hasten resolution of acute otitis media or sinusitis, the majority of clinically diagnosed cases resolve just as quickly with no antibiotics. This is because many cases are misdiagnosed, some cases are viral and even the bacterial cases often quickly spontaneously resolve.
Studies have shown that parents often prefer that their children do not receive antibiotics. Many parents are willing to accept the notion that children with nonsevere bacterial infections often do not benefit from antibiotics.
We are becoming more aware of the potential long-term effects of altering the gut flora of children by prescribing antibiotics. There may be a link with obesity and reactive airways disease and other unexpected conditions.
The old saying goes ‘You can't teach an old dog new tricks’. If you feel like ‘an old dog’ and find it difficult to change decades of practice, you may want to consider giving parents a ‘deferred prescription’. They go home with a prescription that they can fill in 24–48 hours if their child is getting worse. Studies have shown that parents like the degree of control that this provides them, with many never filling the prescription as the child quickly recovered.
Declaration of interest
No conflicts of interest.