A Cochrane review [Abstract] 1 included 7 studies with a total of 824 subjects. Six studies did not find any difference between antibiotics and placebo for their primary outcomes of length of illness (1 study, n=52) or length of hospital stay (5 studies). A small study (n=21) found that 3 weeks of clarithromycin reduced hospital readmission compared to placebo in children with proven RSV infection. This results was not replicated in a more recent study (n=97) comparing a single large dose of azithromycin and placebo.
Meta-analysis was possible for deaths, length of supplemental oxygen use, and length of hospital admission. No deaths were observed in any arms of the 7 included studies. There was no difference in days of supplementary oxygen between antibiotics (azithromycin) and placebo (MD -0.20 days, 95% CI -0.72 to 0.33 days; 3 studies, n=350), nor in length of hospital stay between antibiotics (azithromycin) and control (MD -0.58 days, 95% CI -1.18 to 0.02 days; 3 studies, n=350).Two studies randomised children to intravenous ampicillin, oral erythromycin and control and found no difference for most symptom measures.
Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment).
Clinical comment: Children with a serious illness requiring admission to intensive care and especially those requiring ventilation may have higher rates of bacterial co-infection possibly justifying the use of antibiotics in this setting.
Primary/Secondary Keywords