Duration of symptoms of respiratory tract infections in children: systematic review

Abstract

Objective: To determine the expected duration of symptoms of common respiratory tract infections in children in primary and emergency care.

Design: Systematic review of existing literature to determine durations of symptoms of earache, sore throat, cough (including acute cough, bronchiolitis, and croup), and common cold in children.

Data sources: PubMed, DARE, and CINAHL (all to July 2012).

Eligibility criteria for selecting studies: Randomised controlled trials or observational studies of children with acute respiratory tract infections in primary care or emergency settings in high income countries who received either a control treatment or a placebo or over-the-counter treatment. Study quality was assessed with the Cochrane risk of bias framework for randomised controlled trials, and the critical appraisal skills programme framework for observational studies.

Main outcome measures: Individual study data and, when possible, pooled daily mean proportions and 95% confidence intervals for symptom duration. Symptom duration (in days) at which each symptom had resolved in 50% and 90% of children.

Results: Of 22,182 identified references, 23 trials and 25 observational studies met inclusion criteria. Study populations varied in age and duration of symptoms before study onset. In 90% of children, earache was resolved by seven to eight days, sore throat between two and seven days, croup by two days, bronchiolitis by 21 days, acute cough by 25 days, common cold by 15 days, and non-specific respiratory tract infections symptoms by 16 days.

Conclusions: The durations of earache and common colds are considerably longer than current guidance given to parents in the United Kingdom and the United States; for other symptoms such as sore throat, acute cough, bronchiolitis, and croup the current guidance is consistent with our findings. Updating current guidelines with new evidence will help support parents and clinicians in evidence based decision making for children with respiratory tract infections.

Fig 1 Flow of included randomised controlled trials of respiratory tract infections in children

Fig 2 Flow of included observational studies of respiratory tract infections in children

Fig 3 Proportion of children with symptoms of earache. Symptom duration before study onset was less than four days in five studies (Burke, Damoiseaux, Le Saux, Neumark, Jedrychowski22) and was not reported in three studies (Tahtinen, Greenberg, Smith23)

Fig 4 Proportion of children with symptoms of sore throat. Symptom duration before study onset ranged between 24 hours (median) (Nelson26) to less than one week (Ruperto28) and was not reported in one study (Olympia27). *Children with group A streptococcal infection; †children without group A streptococcal infection or other culture. (Pooling not possible because of lack of data)

Fig 5 Proportion of children with symptoms of cough. Symptom duration before study onset ranged between <48 hours (Jedrychowski22) to <14 days (Bernard30) and was not reported in one study (Kusel37)

Fig 6 Proportion of children with symptoms of croup. Mean symptom duration before study onset was reported as 0.8 (2.4) days (Bjornson31), 1.04 (1) days (Cruz32), and 21 (54) hours (Geelhoed33)

Fig 7 Proportion of children with symptoms of bronchiolitis. Symptom duration before study was median four days in three studies (Patel, Plint 2009, Plint 200439) and not reported in one study (Petruzella38)

Fig 8 Proportion of children with symptoms of common cold. Symptom duration before study onset was not reported in five studies (Hutton, Macknin, Gruber, Pappas, Steinweg), Jedrychowski et al reported duration <48 hours. *Placebo arm; †no treatment arm; ‡children with clear rhinorrhoea; §children with purulent rhinorrhoea

Fig 9 Proportion of children with non-specific respiratory symptoms. Symptom duration before study onset ranged between ≤24 hours (Taylor 200343) to 8.7 (5.1) mean days (Kristo41) and was not reported in five studies (Carabin, Kusel, Mitra, Taylor 2010, Von Linstow54). *Middle meatal pathogen present; †middle meatal pathogen absent