Antibiotics for bronchiolitis in children

Spurling GKP, Fonseka K, Doust J, Del Mar C

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Summary

Bronchiolitis is a common, potentially serious lung infection common in babies

Most cases are thought to be caused by a virus called Respiratory Syncytial Virus (RSV). It is the most common reason for hospitalisation in babies under the age of six months. Despite its viral cause, antibiotics are prescribed in 34 to 99% of cases. This systematic review found very little research on the effect of antibiotics on bronchiolitis. Only one trial was included comparing antibiotics with placebo. It showed that antibiotics are no better than placebo at reducing the length of illness of bronchiolitis. Antibiotics need to be used cautiously owing to potential for side effects, cost to the patient and the community and increasing bacterial resistance to antibiotics.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Spurling GKP, Fonseka K, Doust J, Del Mar C. Antibiotics for bronchiolitis in children. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD005189. DOI: 10.1002/14651858.CD005189.pub2.

This version first published online: January 24. 2007

Abstract

Background

Bronchiolitis is a serious, potentially life-threatening respiratory illness commonly affecting young babies. It is most often caused by Respiratory Syncytial Virus (RSV). Diagnosis is usually made on clinical grounds (especially tachypnoea and wheezing in a child less than two years of age). Antibiotics are not recommended for bronchiolitis unless there is concern about complications such as secondary bacterial pneumonia. Nevertheless, they are used at rates of 34 to 99% in uncomplicated cases.

Objectives

To evaluate the use of antibiotics for bronchiolitis.

Search strategy

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) which includes the Acute Respiratory Infection Groups' specialized register, the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library 2006, issue 3); MEDLINE (January 1966 to August Week 2, 2006); EMBASE (1990 to March 2006); and Current Contents (2001 to September 2006).

Selection criteria

Types of studies: single or double blind randomised controlled trials comparing antibiotics to placebo in the treatment of bronchiolitis.
Types of participants: children under the age of two years diagnosed with bronchiolitis using clinical criteria (including respiratory distress preceded by coryzal symptoms with or without fever).
Types of interventions: oral, intravenous, intramuscular or inhaled antibiotics versus placebo.
Types of outcome measures: primary clinical outcomes: time for the resolution of symptoms/signs (pulmonary markers: respiratory distress; wheeze; crepitations; oxygen saturation; and fever).
Secondary outcomes: hospital admissions; time to discharge from hospital; re-admissions; complications/adverse events developed; and radiological findings.

Data collection and analysis

Data were analysed using Review Manager software, version 4.2.7.

Main results

One study met our inclusion criteria. It randomised children presenting clinically with bronchiolitis to either ampicillin or placebo. The main outcome measure was duration of illness and death. There was no significant difference between the two groups for length of illness and there were no deaths in either group.

Authors' conclusions

This review found no evidence to support the use of antibiotics for bronchiolitis. This results needs to be treated with caution given only one RCT justified inclusion. It is unlikely that simple RCTs of antibiotics against placebo for bronchiolitis will be undertaken in future. Research to identify a possible small subgroup of patients presenting with bronchiolitis-like symptoms who may benefit from antibiotics may be justified. Otherwise, research may be better focused on determining the reasons for clinicians to use antibiotics so readily for bronchiolitis, and ways of reducing their anxiety, and therefore their use of antibiotics for bronchiolitis.

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