Experts have outlined seven key predictors to help GPs identify which children need antibiotics when they present with a cough.

Infections of the respiratory tract with a cough are the most common reason children are prescribed antibiotics, but previous studies have shown up to a third of those prescriptions may be unnecessary.

Researchers in UK say there are key predictors - like a high temperature or severe vomiting – that can determine which children do not need antibiotics, and hopefully help reduce excessive antibiotic use.

A study of over 8,000 children has been used to create the first version of the tool ‘STARWAVe’, a mnemonic device for the following seven predictors::

  • Short illness (less than 3 days)
  • high Temperature (≥37.8°C on examination or parent reported severe fever in the previous 24 hours)
  • Age of under 2 years
  • Respiratory distress, Wheeze, Asthma, and moderate/severe Vomiting in the previous 24 hours

The authors say the tool must be tested in randomised trials, but could be useful in improving the targeting of antibiotics to reduce the growing threat of antibiotic resistance.

They used data collected between July 2011 and May 2013 from almost 8,400 children aged between 3 months and 16 years with acute (less than 28 days) cough and respiratory tract infection symptoms, identifying the seven characteristics were independently linked with hospitalisation.

The authors then developed a scoring system for a child’s risk of future hospitalisation:

  • a child showing 0-1 of these characteristics would be at very low risk of hospitalisation (0.3 per cent risk; 67 per cent of children in the study)
  • a child with 2-3 of these characteristics would be at normal risk, similar to the general population (1.5 per cent risk; 30 per cent of children in the study)
  • a child showing 4 or more would be a high risk candidate for future hospitalisation (11.8 per cent risk; 3 per cent of children in the study)

According to the authors, a ‘no antibiotic’ prescribing strategy would be appropriate for low risk children; a ‘no antibiotic or delayed antibiotic’ treatment strategy would be best for normal risk children, while children deemed at high risk of hospitalisation should be closely monitored for signs of deterioration and followed-up within 24 hours.

“We hope that our proposed clinical tool might eventually enable doctors to quickly and easily identify their lowest and highest risk patients, although more research will be needed to determine just how effective it is in clinical practice,” says lead author Professor Alastair Hay from the University of Bristol.

“The rule should supplement not replace clinical judgement, and doctors and nurses should still advise parents about the symptoms and signs they should look out for, and when to seek medical help.”

The full study is accessible here.