Comparison with existing literature
bacterial infections, infections, fever
BACTERIAL INFECTIONS, INFECTIONS
Children given antibiotics in the observational study had more severe clinical presentations than children not given antibiotics — matching the same trends in the much larger STARWAVe cohort.Despite major differences in the clinical presentation between children given or not given antibiotics, in the current study it was found that when controlling for the propensity to prescribe antibiotics the main outcomes for the combined trial and observational data were very similar to the ‘pure’ trial data. An HR of 1.2 represents around 1 day’s difference because of antibiotics, so a hazard ratio of 1.16 is on average <1 day’s benefit from antibiotics. For the subgroup analyses, although there was some suggestive evidence of differences for some subgroups, the interaction terms were not statistically significant. For children with productive sputum or fever, the lower CIs for the HRs were only just above the null, so it is possible these are chance findings. The estimates of benefit for both the above subgroups were also not very important clinically (neither subgroup had a difference in symptom duration of >2 days). If, as the current study suggests, antibiotics are not effective this may be in part because of antibiotics not working for infections caused predominantly by viruses — but the authors of the current study in a previous publication have shown that bacterial infections were common in this cohort, and that the presence of bacteria did not predict benefit from antibiotics.