Broad Spectrum Antibiotics in Kids - No More Effective, More Complications

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Broad spectrum vs narrower spectrum antibiotics for routine pediatric respiratory infections were not more effective and were associated with an increased rate of complications.

Why does this matter?
Antibiotic resistance is ever increasing.  Part of antibiotic stewardship is using the correct antibiotic.  Overly broad spectrum antibiotics increase the chance of promoting resistant organisms.  Why drop a nuclear bomb, when you could take out the target with a laser?

Broader isn't better
This was a retrospective and prospective cohort study of children with acute respiratory infections (otitis media, strep, sinusitis) receiving antibiotic treatment in numerous pediatric primary care practices.  They found in the retrospective arm of the study that in over 30,000 children with otitis media, sinusitis, and strep pharyngitis that broad spectrum antibiotics (defined as cephalosporins, macrolides, or amoxicillin-clavulanate) were not associated with a reduction in treatment failure.  For the 2472 patients followed in the prospective arm, they found that broad spectrum antibiotics were associated with adverse effects more often, as noted by the pediatricians and as reported by the parents.  So if you're writing for cefdinir when you could use amoxicillin, you are promoting antibiotic resistance and increasing the chance your patient will experience complications from the medicine.

Source
Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections. JAMA. 2017 Dec 19;318(23):2325-2336. doi: 10.1001/jama.2017.18715.

Peer reviewed by Thomas Davis, MD.

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