Systematic review of the treatment of upper respiratory tract infection

Arch Dis Child. 1998 Sep;79(3):225-30. doi: 10.1136/adc.79.3.225.


Objectives: To assess the risks and benefits of antibiotic treatment in children with symptoms of upper respiratory tract infection (URTI).

Design: Quantitative systematic review of randomised trials that compare antibiotic treatment with placebo.

Data sources: Twelve trials retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists); no restriction on language.

Main outcome measures: The proportion of children in whom the clinical outcome was worse or unchanged; the proportion of children who suffered complications or progression of illness; the proportion of children who had side effects.

Results: 1699 children were randomised in six trials that contributed to the meta-analysis. Six trials were not used in the meta-analysis because of different outcomes or incomplete data. Clinical outcome was not improved by antibiotic treatment (relative risk 1.01, 95% confidence interval (CI) 0.90 to 1.13), neither was the proportion of children suffering from complications or progression of illness (relative risk 0.71, 95% CI 0.45 to 1.12). Complications from URTI in the five trials that reported this outcome was low (range 2-15%). Antibiotic treatment was not associated with an increase in side effects compared with placebo (relative risk 0.8, 95% CI 0.54 to 1.21).

Conclusions: In view of the lack of efficacy and low complication rates, antibiotic treatment of children with URTI is not supported by current evidence from randomised trials.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Humans
  • Infant
  • Infant, Newborn
  • Randomized Controlled Trials as Topic
  • Respiratory Tract Infections / complications
  • Respiratory Tract Infections / drug therapy*
  • Risk Assessment
  • Treatment Outcome


  • Anti-Bacterial Agents