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Purulent complications of respiratory infections in young children

Respiratory tract infections (PIDs) are a very large and heterogeneous group of infectious diseases in which the lesion is generally not limited to a specific area of the upper respiratory tract. The duration of the PID is generally up to 7 days. IDPs are more common in preschool children and in low-income countries. IDUs account for 75% of all antibiotic prescriptions in high-income countries. One of the possible reasons for the widespread use of antibiotics for IDPs is the desire to prevent the development of bacterial complications in common respiratory infections of the upper respiratory tract in children.

The objective of the systematic review and meta-analysis performed as part of the Cochrane Collaboration was to assess the efficacy and safety of the use of antibiotics in preventing complications in children under the age of 59 months with undifferentiated IDPs.

The research was conducted in the CENTRAL 2023 (number 4), MEDLINE (for the period from 1950 to May 2023) and EMBASE (from 1974 to May 2023) medical databases. To be included in a systematic review, randomized controlled trials (RCTs) or pseudo-randomized trials were selected that compared the use of placebo or placebo antibiotics or no treatment in children younger than 59 months with PID undifferentiated having lasted less than 7 days. Two experts independently selected the studies to be included in the meta-analysis, assessed their quality and extracted the data necessary for the analysis in accordance with Cochrane's standard methodological methods.

A total of 4 studies were identified with a total number of participants of 1314. In 3 studies, the use of amoxicillin / clavulanate in the prevention of acute otitis media was studied, and one study evaluated the effectiveness ampicillin for the prevention of pneumonia.

The risk of developing otitis media with amoxicillin / clavulanate compared to placebo was found to be 0.7 (95% confidence interval 0.45-1 , 11, 3 studies, 414 children, moderate quality of evidence). In 2 studies, the methods used during randomization were not described in detail and the method of masking the order of assignment of study participants to a particular group ("concealment of allocation") was not specified. In addition, in the 3 studies analyzed, systematic errors were not excluded: 1) linked to the course of the study (performance bias), 2) linked to the identification of results (detection bias) and 3 ) communication of information by parents of patients (bias reporting).

Comparing ampicillin to future management (continued breastfeeding, cleaning the nasal passages and prescribing paracetamol to relieve fever), the risk ratio for pneumonia was found to be 1.05 ( 95% CI 0.74-1.49, one study, 889 children, moderate quality of evidence). This study was "blindless". As in the previous analysis of the effectiveness of antibiotics in preventing otitis media, this study did not describe in detail the method used to randomize the study participants into groups and did not not specified a method to mask the order of assignment of study participants to one or the other group, it was therefore completely impossible to eliminate the possibility of errors associated with the communication of information by parents of patients (reporting bias).

Negative results could not be analyzed because they were only expressed as a percentage. During the meta-analysis, no study evaluated the effectiveness of antibiotics in the prevention of mastoiditis, paratonsillary abscess, meningitis, death or hospitalization in a hospital.

The evidence currently available does not provide rigorous recommendations on the use of antibiotics as a means of reducing the risk of developing otitis media or pneumonia in children under 5 years of age with undifferentiated IDPs. In order to obtain clearer recommendations on the efficacy of antibiotics in this population of patients with IDP, it is necessary to conduct well-organized studies at a high methodological level in the future.