Treatment Outcomes of the Uncomplicated Upper
Respiratory Tract Infection and Acute Diarrhea in
Preschool Children Comparing Those with and
without Antibiotic Prescription
Warunee Punpanich Vandepitte MD, PhD*,
Rachada Ponthong MSc**, Suchada Srisarang MSc***
* Infectious Disease Unit, Department of Pediatrics, Queen Sirikit National Institute of Child Health,
College of Medicine, Rangsit University, Bangkok, Thailand
** Routine to Research Office, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
*** Clinical Research Unit, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
Affiliation :
Background : Upper respiratory tract infection (URI) and acute diarrhea are the two most common reasons for ambulatory
visits among young children. Unnecessary use of antibiotics to treat such conditions pose significant financial burden and
can result in untoward side effects as well as risk of antimicrobial resistance. On the other hand, inadequate antibiotic
treatment in certain cases may increase the risk of suppurative complications and/or invasive infection in this population.
Objective : To compare the treatment outcomes between those with and without antibiotic treatment for the uncomplicated
upper respiratory tract infection and acute diarrhea in young children.
Material and Method: A prospective observational study was conducted in two groups of previously healthy children
presenting with acute uncomplicated URI (aged 2 to 5 years) or acute diarrhea (aged 6 months to 5 years). On initial
enrolment date, patients were treated by a pediatrician who was not a member of the study investigators. The decision for
antibiotic prescription was based entirely on attending physicians’ discretion. Data regarding clinical presentations,
diagnosis, treatment options, and reasons for antibiotic prescription (if any) were collected. Follow-up phone interviews
were conducted on day 3 of enrolment to evaluate treatment outcomes.
Results : Two hundred nine cases with symptoms compatible with acute URI, and/or 199 cases with acute diarrhea were
enrolled between August and November 2013. Antibiotic prescription rates for URI and diarrhea groups were 30.2% and
13.6%, respectively. Among children presenting with URI symptoms, 80.4% (n = 168) were classified as having upper
respiratory tract infection e.g., common cold, acute sinusitis, pharyngitis whereas the other 19.6% were diagnosed with
other conditions e.g., lower respiratory tract infection, pneumonia, viral exanthema after evaluation by a pediatrician.
Overall improvement rates on day 3 were 92.3% and 86.9% for uncomplicated URI and diarrhea group, respectively. Among
URI group, parental satisfaction rates were 100% and 96.6% in those received and did not receive antibiotic, respectively
(p = 0.188), whereas in the diarrhea group, there were 100% and 92.7, (p = 0.35), respectively. Univariate analyses indicated
that the crude odds ratios (OR) and 95% confidence intervals (CI) of treatment failure comparing those with and without
antibiotics were 0.5 (0.2, 1.7) and 1.5 (0.6, 3.7) for URI and diarrhea, respectively. Logistic regression analyses indicated
that antibiotic treatment was not significantly associated with better treatment outcomes for both URI and diarrhea cases
i.e., adjusted ORs and 95% CI of antibiotic for requirement of additional treatment were 1.06 (0.14, 8.15) for URI cases.
Further, adjusted OR and 95% CI of antibiotic for treatment failure was 0.8 (0.2, 2.9) for acute diarrhea cases.
Conclusion : Antibiotic did not appear to provide clinical benefit in the management of uncomplicated URI and/or acute
diarrhea among previously healthy young children.
Keywords : Upper respiratory tract infection, Acute diarrhea, Children, Clinical outcomes, Antibiotics
All Articles
Download