Respiratory tract symptoms in children last longer than expected

Question

For common respiratory tract infections in children, what is the best guidance we can give parents regarding the time to symptom resolution?

Bottom Line

No one has come up with a quick-fix-acillin for children with respiratory tract infections, which last longer than we expect and certainly longer than we want. The time for half the children with earache to be pain free is 3 days, but the time for 9 of 10 children to be pain free is 7 to 8 days. Sore throat symptoms will linger for at least 3 days in one third of children and 72% will have fever for at least 2 days. Cough will resolve in 50% of children within 10 days, but for the rest it will be another 2 weeks. For half the children, general symptoms of a common cold will last for at least 10 days. (LOE = 1a-)

Reference

Thompson M, Vodicka TA, Blair PS, et al, for the TARGET Programme Team. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013;347:f2027.

Synopsis

To determine the duration of symptoms in children seeking treatment for earache, sore throat, cough, and common cold, these authors identified 23 randomized trials and 25 observational studies by searching 3 databases, including DARE. They only included studies published in English and conducted in high-income countries. They excluded studies of children with chronic infection or medical conditions associated with a high risk of serious infections. Two authors reviewed articles for inclusion and also assessed the quality of the included studies. Most studies had a low risk of bias, but the researchers were often unable to combine data because of differences in outcomes. Earache was reported to resolve in 50% of children within 3 days and in 90% by 7 to 8 days. Fever lasted an average of 3 days. For children with sore throat, approximately one third will still have pain at day 3 and 72% will have fever for at least 2 days. Cough resolved in 50% of children at 10 days, but it took 25 days for 90% of children to be cough free. Similarly, 50% of children with bronchiolitis will improve by day 13. For nonspecific respiratory tract infections (ie, the common cold), 50% of children will improve by 10 days.

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
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