Acute Respiratory Tract Infections (RTIs) are very common in children and, although they are predominantly viral in origin and self-limiting, are a major cause of inappropriate antibiotic prescribing in primary care. Numerous strategies and interventions are being developed to optimize antibiotic prescribing for acute RTIs. In this article, we review the evidence that early use of erdosteine in children with acute RTIs of viral origin may reduce unnecessary antibiotic prescribing in the primary care setting. Erdosteine is an oral mucolytic agent that also has antibacterial and anti-inflammatory effects which are relevant for the treatment of respiratory diseases. Several randomised clinical studies in children with acute lower RTIs have shown that combined treatment with erdosteine and an antibiotic enables a more rapid improvement in symptoms, particularly cough, than antibiotic therapy alone. We describe the ERICA study, a non-interventional, observational, multicentre study performed in routine general practice in the Czech Republic over the 2014?2015 winter season in 342 children with a history of recurrent RTIs (≥2) treated with antibiotics in the previous winter season. During the monitored season, all children were prescribed erdosteine at initial presentation for an acute viral RTI, but only 21 (4.4%) of the 473 RTIs resulted in an antibiotic prescription. The mean number of antibiotics used was 0.06 versus 2.32 in the previous season (p<0.001). Also, 73.4% experienced only one RTI during the season. This is the first real-world primary care study to show that prompt use of erdosteine at the initial signs of an acute RTI of presumed viral origin results in a large reduction in antibiotic use and fewer respiratory infections in children with a history of recurrent RTI, many of whom were preschool age and had allergic disorders. Further studies with erdosteine are needed to confirm these findings.
Frantisek Kopriva, Vendula Latalova