Early Antibiotic Use in At-Risk Children with Influenza-Like Illness

Pavankumar Kamat


April 27, 2021


  • There is no evidence that early co-amoxiclav treatment lowers the risk of clinical deterioration in ‘at risk’ children with influenza-like illness (ILI) in primary or ambulatory care.

Why this matters

  • Findings do not support immediate antibiotic prescribing in ‘at risk’ children with seasonal ILI in primary or ambulatory care outside influenza pandemic periods.

Study design

  • In the double-blind, placebo-controlled ARCHIE trial, 271 ‘at risk’ children with ILI (age, 6 months to 12 years) who were randomly assigned (1:1) to receive either oral co-amoxiclav 400/57 (n=136) or placebo (n=135) twice daily for 5 days.

  • Primary outcome: re-consultation because of clinical deterioration within 28 days.

  • Funding: NIHR Programme Grants for Applied Research Programme.

Key results

  • There was no significant difference between co-amoxiclav and placebo groups in the risk of re-consultation because of clinical deterioration (adjusted risk ratio [aRR], 1.16; 95% CI, 0.75-1.80; P=.513).

  • No significant differences were seen between the 2 groups in (aRR; 95% CI):

    • medication prescription or further investigations (1.24; 0.84-1.83; P=.274); and

    • hospitalisation or death (1.00; 0.36-2.77; P=.997).

  • No significant difference was seen between the 2 groups in the proportion of children who reported ≥1 adverse event (aRR, 1.45; 95% CI, 0.90-2.34; P=.131).

  • Overall, 37 adverse events were reported in the co-amoxiclav group and 29 in the placebo group.

  • Overall, 9 serious adverse events were reported in each group, but none were related to the study drug.


  • Small sample size.


Wang K, Semple MG, Moore M, Hay AD, Tonner S, Galal U, Grabey J, Carver T, Perera R, Yu LM, Mollison J, Little P, Farmer A, Butler CC, Harnden A. The early use of Antibiotics for at Risk CHildren with InfluEnza-like illness (ARCHIE): a double-blind randomised placebo-controlled trial. Eur Respir J. 2021 Mar 18 [Epub ahead of print]. doi: 10.1183/13993003.02819-2020. PMID: 33737410. View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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