The early use of Antibiotics for At-risk children with InfluEnza in Primary Care (the ARCHIE programme)

Background Influenza and influenza-like illness place significant burden on the NHS. Children with underlying health conditions are vulnerable to developing bacterial complications. Objective To strengthen evidence base antibiotic use in at-risk children illness. Design This programme comprised five separate work packages. Work package A investigated published unpublished data from previously literature B explored attitudes of parents general practitioners antibiotics children. was followed by a clinical trial assess effectiveness early co-amoxiclav (Augmentin ® , GlaxoSmithKline UK) at reducing reconsultation due deterioration (work C), nested sub-study examine carriage indicators resistance D) within-trial economic evaluation risk prediction analysis E). Setting Interviews were conducted telephone across UK parents/guardians England B). We C packages D E) practices ambulatory care services Wales. Participants General who had participated B. At-risk aged 6 months 12 years E optionally D. Interventions The intervention for 5-day course 400/57 dosing regimens based British National Formulary guidance. Main outcome measures Hospital admission A); findings semi-structured interviews patients health-care professionals B); proportion reconsulted owing C); respiratory potentially pathogenic tract bacteria 3, 6, 9 D); factors deterioration, quality life (EuroQol-5 Dimensions, three-level youth version), symptoms (Canadian Acute Respiratory Infection Flu Scale), costs Review methods For A, we searched MEDLINE, MEDLINE In-Process, EMBASE, Science Citation Index CINAHL (Cumulative Nursing Allied Health Literature) databases until 3 April 2013 no language restrictions requested authors studies which collected but not relevant data. included involving up 18 age influenza or primary settings. used univariable meta-analysis calculate odds ratios 95% confidence intervals individual factors. reported our systematic review according PRISMA (Preferred Reporting Items Systematic Reviews Meta-Analyses) 2009 statement. Results analysed 28 articles reporting 27 studies. Neurological disorders, sickle cell disease, immunosuppression, diabetes an <2 hospital admission. interviewed 41 found that decision-making varies considerably. Parents/guardians spoke how quickly their child could deteriorate. They supportive while being aware resistance. C) recruited 271 Primary available 265 There benefit treatment versus placebo (adjusted ratio 1.16, interval 0.75 1.80). 285 additional throat swabs over months. At months, Haemophilus influenzae isolates greater than group (29% vs. 18%). No association between use. features significantly associated except rate (coefficient 0.046, 0.010 0.081). improves reduces costs. Total per patient highly skewed both groups (co-amoxiclav: median £4, range £4–5258; placebo: £0, £0–5177). Limitations able recruit target sample size trial. impacted microbiology, economics reduction score analyses. Conclusions Our results do support prescribing during season. Future Further research is required determine if would be beneficial periods higher activity such as pandemics, identify gain most better understand families’ decisions. Trial registration registered ISRCTN70714783 EudraCT 2013-002822-21. Funding project funded Institute Care Research (NIHR) Programme Grants Applied will full ; Vol. 11, No. 1. See NIHR Journals Library website further information.