Antibiotics for sore throat

Background: Sore throat is a common reason for people to present for medical care. Although it remits spontaneously, primary care doctors commonly prescribe antibiotics for it. Objectives: To assess the benefits of antibiotics for sore throat for patients in primary care settings. Search methods: We searched CENTRAL 2013, Issue 6, MEDLINE (January 1966 to July week 1, 2013) and EMBASE (January 1990 to July 2013). Selection criteria: Randomised controlled trials (RCTs) or quasi‐RCTs of antibiotics versus control assessing typical sore throat symptoms or complications. Data collection and analysis: Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. We contacted trial authors from three studies for additional information. Main results: We included 27 trials with 12,835 cases of sore throat. We did not identify any new trials in this 2013 update. 1. Symptoms - Throat soreness and fever were reduced by about half by using antibiotics. The greatest difference was seen at day three. The number needed to treat to benefit (NNTB) to prevent one sore throat at day three was less than six; at week one it was 21. 2. Non‐suppurative complications - The trend was antibiotics protecting against acute glomerulonephritis but there were too few cases to be sure. Several studies found antibiotics reduced acute rheumatic fever by more than two‐thirds within one month (risk ratio (RR) 0.27; 95% confidence interval (CI) 0.12 to 0.60). 3. Suppurative complications - Antibiotics reduced the incidence of acute otitis media within 14 days (RR 0.30; 95% CI 0.15 to 0.58); acute sinusitis within 14 days (RR 0.48; 95% CI 0.08 to 2.76); and quinsy within two months (RR 0.15; 95% CI 0.05 to 0.47) compared to those taking placebo. 4. Subgroup analyses of symptom reduction - Antibiotics were more effective against symptoms at day three (RR 0.58; 95% CI 0.48 to 0.71) if throat swabs were positive for Streptococcus, compared to RR 0.78; 95% CI 0.63 to 0.97 if negative. Similarly at week one the RR was 0.29 (95% CI 0.12 to 0.70) for positive and 0.73 (95% CI 0.50 to 1.07) for negative Streptococcus swabs. Authors' conclusions: Antibiotics confer relative benefits in the treatment of sore throat. However, the absolute benefits are modest. Protecting sore throat sufferers against suppurative and non‐suppurative complications in high‐income countries requires treating many with antibiotics for one to benefit. This NNTB may be lower in low‐income countries. Antibiotics shorten the duration of symptoms by about 16 hours overall.Griffith Health, School of MedicineFull Tex

Quantifying the risk of sports injury: a systematic review of activity‐specific rates for children under 16 years of age

Injuries caused by sports and other forms of physical activity in young children constitute a significant public health burden. It is important to quantify this risk to ensure that the benefits of sport participation are not outweighed by the potential harms. This review summarises the literature reporting exposure‐based injury rates for various forms of physical activity in children aged 15 years and younger. Forty eight studies were found, of which 27 reported injury rates per hourly based exposure measured and 21 reported injury rates according to some other measure. Fourteen different sports and activities were covered, mostly team ball sports, with soccer being the most widely studied. Injury definition and the method of ascertaining and measuring injuries differed between studies, which created a large variation in reported injury rates that did not necessarily represent actual differences in injury risk between activities. The highest hourly based injury rates were reported for ice hockey, and the lowest were for soccer, although the range of injury rates for both of these activities was wide. Very few studies have investigated sports‐related injuries in children younger than 8 years or in unorganised sports situations

Antibiotics for treatment of sore throat in children and adults

BACKGROUND: Sore throat is a common reason for people to present for medical care and to be prescribed antibiotics. Overuse of antibiotics in primary medicine is a concern, hence it is important to establish their efficacy in treating sore throat and preventing secondary complications.  OBJECTIVES: To assess the effects of antibiotics for reducing symptoms of sore throat for child and adult patients. SEARCH METHODS: We searched CENTRAL 2021, Issue 2, MEDLINE (January 1966 to April week 1, 2021), Embase (January 1990 to April 2021), and two trial registries (searched 6 April 2021). SELECTION CRITERIA: Randomised controlled trials (RCTs) or quasi‐RCTs of antibiotics versus control assessing typical sore throat symptoms or complications amongst children and adults seeking medical care for sore throat symptoms. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as recommended by Cochrane. Two review authors independently screened studies for inclusion and extracted data, resolving any differences in opinion by discussion. We contacted the trial authors from three studies for additional information. We used GRADE to assess the certainty of the evidence for the efficacy of antibiotics on our primary outcomes (sore throat at day three and one week) and secondary outcomes (fever and headache symptoms and incidence of acute rheumatic fever, acute glomerulonephritis, acute otitis media, acute sinusitis, and quinsy). MAIN RESULTS: We included 29 trials with 15,337 cases of sore throat. The majority of included studies were conducted in the 1950s, during which time the rates of serious complications (especially acute rheumatic fever) were much higher than today. Although clinical antibiotic trials for sore throat and respiratory symptoms are still being conducted, it is unusual for them to include placebo or 'no treatment' control arms, which is a requirement for inclusion in the review. The age of participants ranged from younger than one year to older than 50 years, but most participants across all studies were adults. Although all studies recruited patients presenting with symptoms of sore throat, few of them distinguished between bacterial and viral aetiology. Bias may have been introduced through non‐clarity in treatment allocation procedures and lack of blinding in some studies. Harms from antibiotics were poorly or inconsistently reported, and were thus not quantified for this review. 1. Symptoms Throat soreness and headache at day three were reduced by using antibiotics, although 82% of participants in the placebo or no treatment group were symptom‐free by one week. The reduction in sore throat symptoms at day three (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.60 to 0.80; 16 studies, 3730 participants; moderate‐certainty evidence) was greater than at one week in absolute numbers (RR 0.50, 95% CI 0.34 to 0.75; 14 studies, 3083 participants; moderate‐certainty evidence) due to many cases in both treatment groups having resolved by this time. The number needed to treat for an additional beneficial outcome (NNTB) to prevent one sore throat at day three was less than six; at week one it was 18. Compared with placebo or no treatment, antibiotics did not significantly reduce fever at day three (RR 0.75, 95% CI 0.53 to 1.07; 8 studies, 1443 participants; high‐certainty evidence), but did reduce headache at day three (RR 0.49, 95% CI 0.34 to 0.70; 4 studies, 1020 participants; high‐certainty evidence). 2. Suppurative complications Whilst the prevalence of suppurative complications was low, antibiotics reduced the incidence of acute otitis media within 14 days (Peto odds ratio (OR) 0.21, 95% CI 0.11 to 0.40; 10 studies, 3646 participants; high‐certainty evidence) and quinsy within two months (Peto OR 0.16, 95% CI 0.07 to 0.35; 8 studies, 2433 participants; high‐certainty evidence) compared to those receiving placebo or no treatment, but not acute sinusitis within 14 days (Peto OR 0.46, 95% CI 0.10 to 2.05; 8 studies, 2387 participants; high‐certainty evidence). 3. Non‐suppurative complications There were too few cases of acute glomerulonephritis to determine whether there was a protective effect of antibiotics compared with placebo against this complication (Peto OR 0.07, 95% CI 0.00 to 1.32; 10 studies, 5147 participants; low‐certainty evidence). Antibiotics reduced acute rheumatic fever within two months when compared to the control group (Peto OR 0.36, 95% CI 0.26 to 0.50; 18 studies, 12,249 participants; moderate‐certainty evidence). It should be noted that the overall prevalence of acute rheumatic fever was very low, particularly in the later studies. AUTHORS' CONCLUSIONS: Antibiotics probably reduce the number of people experiencing sore throat, and reduce the likelihood of headache, and some sore throat complications. As the effect on symptoms can be small, clinicians must judge on an individual basis whether it is clinically justifiable to use antibiotics to produce this effect, and whether the underlying cause of the sore throat is likely to be of bacterial origin. Furthermore, the balance between modest symptom reduction and the potential hazards of antimicrobial resistance must be recognised. Few trials have attempted to measure symptom severity. If antibiotics reduce the severity as well as the duration of symptoms, their benefit will have been underestimated in this meta‐analysis. Additionally, more trials are needed in low‐income countries, in socio‐economically deprived sections of high‐income countries, as well as in children. 

Quantifying the association between physical activity and injury in primary school-aged children

BACKGROUND. Regular physical activity is strongly advocated in children, with recommendations suggesting up to several hours of daily participation. However, an unintended consequence of physical activity is exposure to the risk of injury. To date, these risks have not been quantified in primary school-aged children despite injury being a leading cause for hospitalization and death in this population. OBJECT. Our goal was to quantify the risk of injury associated with childhood physical activity both in and out of the school setting and calculate injury rates per exposure time for organized and non-organized activity outside of school. METHODS. The Childhood Injury Prevention Study prospectively followed a cohort of randomly selected Australian primary school- and preschool-aged children (4 to 12 years). Over 12 months, each injury that required first aid attention was registered with the study. Exposure to physical activity outside school hours was measured by using a parent-completed 7-day diary. The age and gender distribution of injury rates per 10 000 hours of exposure were calculated for all activity and for organized and non-organized activity occurring outside school hours. In addition, child-based injury rates were calculated for physical activity-related injuries both in and out of the school setting. RESULTS. Complete diary and injury data were available for 744 children. There were 504 injuries recorded over the study period, 396 (88.6%) of which were directly related to physical activity. Thirty-four percent of physical activity-related injuries required professional medical treatment. Analysis of injuries occurring outside of school revealed an overall injury rate of 5.7 injuries per 10 000 hours of exposure to physical activity and a medically treated injury rate of 1.7 per 10 000 hours. CONCLUSION. Injury rates per hours of exposure to physical activity were low in this cohort of primary school-aged children, with < 2 injuries requiring medical treatment occurring for every 10 000 hours of activity participation outside of school

Compliance with the Australian National Physical Activity Guidelines for Children: Relationship to Overweight Status

Childhood obesity incidence has increased substantially and it has been argued that decreasing physical activity levels, coinciding with an increase in sedentary behaviours, are responsible. Australian guidelines were published in 2004, recommending that children participate in a minimum of 60 min of physical activity daily and spend no more than 2 h a day using electronic media for entertainment. We aimed to compare compliance with these guidelines amongst children of differing weight status. The Childhood Injury Prevention Study (CHIPS) collected data from a randomly selected sample of Brisbane primary and preschool children aged 5-12 years. The following data were available for 518 participants: age, gender, measured height and weight and estimated time per week from a parent-completed 7 days diary in physical activity out of school and sedentary leisure activities including television viewing and computer use. Using age standardised body mass index estimates, approximately 20% of the cohort were overweight. Non-compliance with guidelines was 14.7% for out of school physical activity participation, and 30.9% for excess electronic media entertainment use. There was a 63% increase in the odds of overweight status amongst children who were non-compliant with the electronic entertainment recommendations than those who were compliant (adjusted odds ratio = 1.63; 95% Cl = 1.05-2.54). Female gender and school level socioeconomic category were also independently associated with overweight status. Non-compliance with the minimal physical activity guideline increased the odds of being overweight by 28%, however this difference was not statistically significant. One in seven children from the Greater Brisbane area are at risk for being insufficiently active whilst a third overuse electronic media. Given that overuse of electronic entertainment was positively associated with childhood obesity, these children should be the target of public health campaigns to promote alternative leisure time activities. (c) 2006 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved

Host factors and childhood injury: The influence of hyperactivity and aggression

OBJECTIVE: This study examined the association between hyperactivity, aggression, and unintentional childhood injury among a cohort of children aged 5-12 years. Participants were recruited utilizing a two-tier randomization process from primary schools in Brisbane, the capital city of Queensland, Australia. Information on hyperactivity and aggression was collected by trained interviewers using a semi structured questionnaire and episodes of injury were reported by parents using an injury event report form. Eight hundred and seventy-one children were recruited into the study of which 811 (93%) completed the full 12 months of follow-up. All subsequent analysis was limited to the children who were retained for the full study period. METHODS: One hundred and twenty-one children were categorized as hyperactive and 48 as aggressive. Boys were nearly twice as likely as girls to be categorized as hyperactive or aggressive, although this difference was not statistically significant for aggression. Lower socioeconomic status (SES) as measured by household income was also associated with aggression while more children from middle SES households as measured by both household income and maternal education were hyperactive compared with children from either low or high SES households. RESULTS: After adjusting for key confounding factors, children with high hyperactivity scores had an increased risk of all injuries (OR 1.98, 95% CI 1.48-2.64) and medically treated injuries (OR 1.56, 95% CI 1.01-2.43). Male gender was also a significant predictor of injury. Initiatives to prevent childhood injuries should take into account that child temperament may act as a mediating factor in the injury pathway. CONCLUSION: Further research is necessary to determine the success of preventive efforts in higher risk children who may react to their environment in a substantially different manner compared with less hyperactive children

Impact of participant attrition on child injury outcome estimates: a longitudinal birth cohort study in Australia

Background: Longitudinal research is subject to participant attrition. Systemic differences between retained participants and those lost to attrition potentially bias prevalence of outcomes, as well as exposure-outcome associations. This study examines the impact of attrition on the prevalence of child injury outcomes and the association between sociodemographic factors and child injury. Methods: Participants were recruited as part of the Environments for Healthy Living (EFHL) birth cohort study. Baseline data were drawn from maternal surveys. Child injury outcome data were extracted from hospital records, 2006–2013. Participant attrition status was assessed up to 2014. Rates of injury-related episodes of care were calculated, taking into account exposure time and Poisson regression was performed to estimate exposure-outcome associations. Results: Of the 2222 participating families, 799 families (36.0%) had complete follow-up data. Those with incomplete data included 137 (6.2%) who withdrew, 308 (13.8%) were lost to follow-up and 978 families (44.0%) who were partial/non-responders. Families of lower socioeconomic status were less likely to have complete follow-up data (p<0.05). Systematic differences in attrition did not result in differential child injury outcomes or significant differences between the attrition and non-attrition groups in risk factor effect estimates. Participants who withdrew were the only group to demonstrate differences in child injury outcomes. Conclusion: This research suggests that even with considerable attrition, if the proportion of participants who withdraw is minimal, overall attrition is unlikely to affect the population prevalence estimate of child injury or measures of association between sociodemographic factors and child injury

Child injury: does home matter?

This study examined the relationship between home risk and hospital treated injury in Australian children up to five years old. Women with children between two and four years of age enrolled in the Environments for Healthy Living (EFHL): Griffith Birth Cohort Study were invited to complete a Home Injury Prevention Survey from March 2013 to June 2014. A total home risk score (HRS) was calculated and linked to the child's injury related state-wide hospital emergency and admissions data and EFHL baseline demographic surveys.Data from 562 households relating to 566 child participants were included. We found an inverse relationship between home risk and child injury, with children living in homes with the least injury risk (based on the absence of hazardous structural features of the home and safe practices reported) having 1.90 times the injury rate of children living in high risk homes (95% CI 1.15-3.14). Whilst this appears counter-intuitive, families in the lowest risk homes were more likely to be socio-economically disadvantaged than families in the highest risk homes (more sole parents, lower maternal education levels, younger maternal age and lower income). After adjusting for demographic and socio-economic factors, the relationship between home risk and injury was no longer significant (p > 0.05).Our findings suggest that children in socio-economically deprived families have higher rates of injury, despite living in a physical environment that contains substantially fewer injury risks than their less deprived counterparts. Although measures to reduce child injury risk through the modification of the physical environment remain an important part of the injury prevention approach, our study findings support continued efforts to implement societal-wide, long term policy and practice changes to address the socioeconomic differentials in child health outcomes