Comparative Effectiveness of Antibiotics for Respiratory Infections


The purpose of this study is to identify and use patient centered outcomes to compare narrow-spectrum and broad-spectrum antibiotics for the treatment of common acute respiratory tract infections (ARTIs) in children.

Full Title of Study: “Comparative Effectiveness of Broad vs. Narrow Spectrum Antibiotics for Acute Respiratory Tract Infections in Children”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: April 2016

Detailed Description

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.


  • Drug: Broad-spectrum antibiotics
    • Amoxicillin-clavulanate, azithromycin, cefdinir, cefprozil, cefuroxime axetil, cefadroxil, cephalexin
  • Drug: Narrow-spectrum antibiotics
    • Amoxicillin, Penicillin

Arms, Groups and Cohorts

  • Broad-spectrum antibiotics
    • Children diagnosed with an acute respiratory tract infections (ARTI) and prescribed Broad-spectrum antibiotics.
  • Narrow-spectrum
    • Children diagnosed with an acute respiratory tract infections (ARTI) and prescribed Narrow-spectrum antibiotics.

Clinical Trial Outcome Measures

Primary Measures

  • Health Related Quality of Life Score
    • Time Frame: 5-10 days after ARTI diagnosis
    • The health related quality of life score was obtained using the PedsQL(TM) (Mapi Research Trust, Lyon, France. Parent-Proxy Report Generic Core Scales and Parent Report Infant Scales administered during the 5-10 day interview. Briefly, the PedsQL(TM) is a 23-item questionnaire assessing developmentally appropriate metrics (questions vary by age group: 1-12 months, 13-24 months, 2-4 years, 5-7 years, 8-12 years) related to core dimensions of health and role functioning. Our primary outcome was the Total Scale Score, which is a summary score of physical, emotional, social, and school functioning. The score range is zero to 100 and higher scores indicate a better health-related quality of life.

Secondary Measures

  • Missed School or Daycare From Illness
    • Time Frame: 5-10 days after ARTI diagnosis
    • Among children who attend school or daycare, child had to miss school or day care due to illness
  • Required Additional Childcare
    • Time Frame: 5-10 days after ARTI diagnosis
    • Among children who attend school or daycare, parent or another caretaker had to miss work or an obligation due to child’s illness OR additional childcare had to be sought for the child.
  • Experience Side Effects
    • Time Frame: 14-20 days after ARTI diagnosis
    • Child experienced a side effect including: rash, diarrhea or upset stomach/vomiting
  • Symptoms Present on Day 3
    • Time Frame: 3 days after ARTI diagnosis
    • During 5-10 day interview, parents were asked about symptoms related to child’s illness (otitis media: fever, ear pain, decreased appetite; sinusitis: fever, face/head pain, decreased appetite; pharyngitis: throat pain, fever, decreased appetite). Parent was asked if symptoms was present at diagnosis. If yes, had the symptom resolved. If yes, when. We assessed whether symptoms present at day 3 after diagnosis.
  • Sleep Disturbance
    • Time Frame: Days 5-10 Interview
    • The PedsQL questionnaire includes one or two questions, depending on age, about sleep. For children <24 months, parents are asked the frequency (never, almost never, sometimes, often, almost always) their child has (1) “difficulty falling asleep” and (2) “difficulty sleeping through the night.” For children ≥2 years, parents are asked the frequency their child has “trouble sleeping.” We categorized children as either without sleep disturbance (“Never” for each sleep question) or with sleep disturbance. Outcome measure shows the number of participants with sleep disturbance.

Participating in This Clinical Trial

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

Gender Eligibility: All

Minimum Age: 6 Months

Maximum Age: 12 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Children’s Hospital of Philadelphia
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Jeffrey S Gerber, MD, PhD, Principal Investigator, Children’s Hospital of Philadelphia

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