Comparing Narrow- vs. Broad-Spectrum Antibiotics for Common Infections in Children

The choice of antibiotic to treat acute bacterial upper respiratory tract infections in children can affect both symptom resolution and the risk of side effects such as diarrhea and vomiting.


A young Hispanic boy wearing glasses and an orange T-shirt takes medicine from a small measuring cup

The findings of a PCORI-funded study published in JAMA can help clinicians treating children for acute respiratory tract infections (ARTIs)—including acute otitis media, Group A streptococcal pharyngitis, and acute sinusitis—make decisions with parents about the medicine that is best for the child. The study, led by Jeffrey Gerber, a pediatrician and researcher at the Children’s Hospital of Philadelphia, included 30,086 children ages 6 months to 12 years taking narrow- and broad-spectrum antibiotics to treat ARTIs.

Findings From a Recent Study Funded by PCORI

A PCORI-funded study published in JAMA1 found that narrow-spectrum antibiotics such as amoxicillin are just as effective as broad-spectrum alternatives for treating acute respiratory tract infections (ARTIs) in children ages 6 months to 12 years but have a lower risk of side effects.

What the Study Found

  • Symptom resolution: At 72 hours after diagnosis, the rate of symptom resolution was no different between children taking narrow- or broad-spectrum antibiotics.
  • Treatment failure rates: The rate of treatment failure was no different between children taking narrow- or broadspectrum antibiotics.
  • Side effects: The risk of side effects, including diarrhea, candidiasis, allergic reaction, and vomiting, was significantly lower for children taking narrow-spectrum antibiotics compared with children taking broad-spectrum antibiotics.

Read more about the study at:

Professional Guidelines

The American Academy of Pediatrics (AAP)2 and the Infectious Diseases Society of America (IDSA)3 provide guidelines regarding the treatment of ARTIs.

Acute Otitis Media or Strep Throat Infection

Both groups recommend the narrow-spectrum amoxicillin as a first-line treatment for most patients with acute otitis media or strep throat infection.

Acute Sinusitis

The groups have different recommendations for acute sinusitis. AAP recommends amoxicillin, while IDSA recommends the broadspectrum amoxicillin-clavulanate because of reports of children with ARTIs having coinfection with ß-lactamase-producing H. influenzae. The presence of these bacteria renders amoxicillin ineffective, resulting in treatment failure.

Prescribing Patterns for ARTIs

With growing awareness of the importance of the responsible use of antibiotics, unnecessary antibiotic use has declined in recent years. However, the choice between narrow- and broad-spectrum antibiotics has not received the same attention. Clinicians prescribe narrow-spectrum antibiotics in only about half of antibiotic-treated ARTI cases. In a 2016 study of more than 3,000 pediatric patients who were treated with antibiotics for ARTIs, clinicians prescribed penicillin or amoxicillin for 60% of strep throat infections, 54% of acute otitis media, and 39% of acute sinusitis infection cases.4 The remaining cases were treated with other antibiotics such as amoxicillin-clavulanate, macrolides, or broad-spectrum cephalosporins. The two valid reasons for using a broadversus narrow-spectrum antibiotic—allergic reaction to amoxicillin or history of treatment failure with amoxicillin—should account for no more than 20 percent of broad-spectrum antibiotic use.4

Communicating with Parents about Antibiotic Choice

A patient version of this evidence update is available here. This handout, along with your discussion, can help parents understand why you may be prescribing an alternative to a familiar antibiotic, such as Augmentin® or a Z-pak®. Points include:

  • In the Gerber study, narrow-spectrum antibiotics were just as effective as other antibiotics to relieve symptoms.
  • Other antibiotics are not necessarily “stronger” than amoxicillin.
  • Broad-spectrum antibiotics kill more types of bacteria, including “good” bacteria that help with digestion, leading to a greater risk of diarrhea and vomiting.
  • Using broad-spectrum antibiotics when they are not needed increases the likelihood of antibiotic resistance, which may limit the use of these medicines in the future.

Download this Evidence Update


1. Gerber JS, Ross RK, Bryan M, et al. Association of Broad- vs Narrow Spectrum Antibiotics with Treatment Failure, Adverse Events, and Quality of Life in Children with Acute Respiratory Tract Infections. JAMA. 2017;318(23):2325-36.
2. American Academy of Pediatrics. Pneumococcal Infection. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2012:571-581.
3. Chow AW, Benninger MS, Brook I, et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clinical Infectious Diseases. 2012 Apr;54(8):e72-e112.
4. Hersh AL, Fleming-Dutra KE, Shapiro DJ, et al. Frequency of First-line Antibiotic Selection Among US Ambulatory Care Visits for Otitis Media, Sinusitis, and Pharyngitis. JAMA Internal Medicine. 2016;176(12):1870-1872.

The information in this publication is not intended to be a substitute for professional medical advice. This update summarizes findings from a PCORI research award to the Children’s Hospital of Philadelphia.

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