ARTIC PC

Acute respiratory infections are among the commonest conditions managed in primary care.

The Department of Health recognises that antibiotic resistance is an increasingly serious public health problem in England, Europe and the world with rising resistance rates for a range of antibiotics, and a clear relationship between primary care antibiotic prescribing (responsible for 80% of prescribing) and antibiotic resistance.

We are looking to investigate the usefulness of antibiotics in this age group, it follows a European wide trial that was very similar for adults. Children will be provided antibiotic or placebo and keep a symptom diary for up to 28 days. They can opt to provide a throat swab, a blood sample and have a chest xray.

Design: RCT nested in an observational study.

Intervention: 7 days of tds amoxicillin or placebo for those in the RCT

The aim: To provide evidence to inform the management of chest infections in children.

The objectives are:
• To estimate the effectiveness of amoxicillin overall and in key clinical subgroups of children presenting with uncomplicated (non-pneumonic) lower respiratory tract infection in primary care.

• To estimate the cost-effectiveness of antibiotics overall and in key clinical subgroups of children presenting with uncomplicated lower respiratory tract infection in primary care.

• To explore the estimates of effectiveness according to key pathophysiological subgroups (the presence of bacterial pathogens; raised C reactive protein measurement or white cell count; the presence of clinically undetected consolidation on X ray; oximetry; lung function).

Our provisional sub group analysis will be on:
• Sputum seen and/or heard by parents (‘rattly chest’) or by clinician on clinical examination

• History of fever

• Physician rating of being unwell

• Short of breath

• Chest signs (non-focal coarse crepitation’s/rhonchi/wheeze).

Contact: Natalie Thompson artic-pc@soton.ac.uk
This project is being conducted by the Primary Care Research Centre