No Clinical Benefit of Antibiotics in Children with Uncomplicated LRTI

Pavankumar Kamat


September 27, 2021


  • Amoxicillin did not provide additional clinical benefit vs placebo in reducing symptom duration among children with acute uncomplicated lower respiratory tract infections (LRTIs) in primary care.

Why this matters

  • Considering the growing global threat of antibiotic resistance, clinicians should refrain from prescribing antibiotics for most children with chest infections, except pneumonia.

Study details

  • The ARTIC PC trial included 432 children (ages, 6 months-12 years) in primary care with an acute uncomplicated LRTI judged by the physician to be infective in origin, lasting for less than 21 days and with other symptoms or signs localising to the lower respiratory tract.

  • Patients were randomly assigned to receive either amoxicillin 50 mg/kg/day (n=221) or placebo (n=211) orally for 7 days.

  • Primary outcome: duration of moderately bad or worse symptoms.

  • Funding: National Institute for Health Research.

Key results

  • The median duration of moderately bad or worse symptoms was not significantly different between the amoxicillin and placebo groups (5 vs 6 days; HR, 1.13; 95% CI, 0.90-1.42).

  • No significant differences were observed in the symptom duration between the treatment groups among key clinical subgroups that are commonly prescribed antibiotics, i.e., patients with chest signs, physician rating of unwell, fever during illness, sputum or chest rattle and shortness of breath.


  • Results may not be generalisable to other clinical settings.


Little P, Francis NA, Stuart B, O'Reilly G, Thompson N, Becque T, Hay AD, Wang K, Sharland M, Harnden A, Yao G, Raftery J, Zhu S, Little J, Hookham C, Rowley K, Euden J, Harman K, Coenen S, Read RC, Woods C, Butler CC, Faust SN, Leydon G, Wan M, Hood K, Whitehurst J, Richards-Hall S, Smith P, Thomas M, Moore M, Verheij T. Antibiotics for lower respiratory tract infection in children presenting in primary care in England (ARTIC PC): a double-blind, randomised, placebo-controlled trial. Lancet. 2021 Sep 22 [Epub ahead of print]. doi: 10.1016/S0140-6736(21)01431-8.  View full text

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


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