Comparative Effectiveness of Broad vs. Narrow Spectrum Antibiotics for Acute Respiratory Tract Infections in Children

Principal Investigator

Jeffrey Gerber, MD, PhD


Children’s Hospital of Philadelphia

Funding Announcement

Assessment of Prevention, Diagnosis, and Treatment Options



Requested Project Budget*


Year Awarded


Project Period*

3 Years

Project Summary

Antibiotics are the most common medicines prescribed to children. Children often receive antibiotics from their primary care provider for acute respiratory tract infections (ARTI) such as strep throat, ear infections, or sinus infections. Although providers have many choices of antibiotics for treating these infections, the principle that experts recommend to guide antibiotic selection is to start treatment with narrow-spectrum drugs, and to reserve broad-spectrum drugs for the few infections that do not respond to narrow-spectrum drugs or more severe infections that may be resistant to the narrow-spectrum antibiotics. However, providers do not always follow this principle. In fact, broad-spectrum drugs are used first nearly 50% of the time, and given how common these infections are, consequences could be serious: Experts worry that these drugs may not always be effective, result in more side effects, and their use could lead to antibiotic resistance. The obvious question is, “Why?”, and the explanation is complicated. It may be that parents and children prefer broad-spectrum drugs for their convenient dosing schedule and flavor. It may be that providers believe that the drugs are more effective. To help clarify this, more research is needed to compare the effectiveness of narrow-spectrum and broad-spectrum antibiotics—research that includes outcomes relevant to families. To that end, we are proposing a two-part study that will be conducted in one of the largest primary care pediatric practice networks in the United States, including more than 200 providers who care for more than 200,000 children. First, we will interview children and their caregivers who bring them to the pediatrician for an ARTI and ask them what factors are most important to them when it comes to antibiotic use for these infections. These interviews will help us understand which outcomes to include in future comparisons of antibiotics. Second, we will survey parents of children who received antibiotics for an ARTI to compare narrow-spectrum and broad-spectrum antibiotics in terms of their ability to cure the infection and the type and amount of side effects they caused. This study will help inform pediatric providers and parents of the risks and benefits associated with the treatment of these very common infections, and assist providers and parents in arriving at the best decisions for children.

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.

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