Antibiotic treatment for non-specific upper respiratory tract infections and exacerbation risk in children with asthma: A target trial emulation study.
Source: PubMed, NCBI / U.S. National Library of Medicine
Antibiotics are often prescribed to children with asthma for non-specific upper respiratory tract infections (NS-URTIs), but their association with exacerbation risk in children with pre-existing asthma is unclear. We aimed to determine if antibiotics are associated with asthma exacerbation risk in the six months following NS-URTI resolution. Using Quebec administrative health and drug claims data, we emulated a series of target trials among children (0-17 years) with asthma visiting an outpatient physician for a NS-URTI. Treatment strategies were no, narrow-, or broad-spectrum antibiotics initiated within three days following the index visit. The primary outcome was exacerbation during the 6 months following an initial 10-day induction period, defined as oral corticosteroid use, emergency department visits, or hospitalizations for asthma. Risk ratios and differences were estimated using inverse probability of treatment weighted log-binomial models. Among 13 646 children (24 139 person-trials), 8.8% and 11.4% received narrow- and broad-spectrum antibiotics, respectively. Compared with no antibiotics, narrow-spectrum antibiotics were associated with a risk ratio of 1.26 (95%CI, 0.99, 1.53; RD 0.07%), while broad-spectrum antibiotics were associated with a risk ratio of 1.28 (95%CI, 1.03, 1.54; RD 0.08%). Broad-spectrum antibiotics were associated with modestly higher exacerbation risks, although absolute risk differences were small (<0.1%).