---
title: "Antibiotics for NS-URTIs and Asthma Exacerbation Risk in Children: Target Trial Emulation"
id: "pubmed-42281381"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42281381"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42281381/"
doi: "10.1093/aje/kwag132"
published_at: "2026-09-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Antibiotics for NS-URTIs and Asthma Exacerbation Risk in Children: Target Trial Emulation
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42281381
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42281381/)
- **DOI:** [10.1093/aje/kwag132](https://doi.org/10.1093%2Faje%2Fkwag132)
- **Published At:** 2026-09-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study emulated a series of target trials using Quebec administrative health and drug claims data to evaluate whether antibiotics prescribed for **non-specific upper respiratory tract infections (NS-URTIs)** in children with pre-existing asthma are associated with subsequent asthma exacerbation risk. - Population included children aged 0–17 years with asthma who visited an outpatient physician for an NS-URTI; analysis used repeated person-trials when eligibility recurred. - Treatment strategies compared were: no antibiotic (reference), **narrow-spectrum antibiotic**, or **broad-spectrum antibiotic** initiated within 3 days after the index visit. A 10-day induction period was applied and primary follow-up covered 6 months after that period. - Primary outcome was asthma exacerbation during the 6-month follow-up, defined as oral corticosteroid use, emergency department visit, or hospitalization for asthma. - Analysis used inverse probability of treatment weighting with log-binomial models to estimate risk ratios (RR) and risk differences (RD). - Among 13,646 children contributing 24,139 person-trials, 8.8% received narrow-spectrum antibiotics and 11.4% received broad-spectrum antibiotics. - Compared with no antibiotics, narrow-spectrum antibiotics had an RR of 1.26 (95% CI, 0.99–1.53; RD 0.07%). Broad-spectrum antibiotics had an RR of 1.28 (95% CI, 1.03–1.54; RD 0.08%). - Authors conclude broad-spectrum antibiotics were associated with modestly higher exacerbation risks compared with no antibiotics, but absolute risk differences were small (<0.1%). - Conflict of interest disclosures and funding sources are reported for authors; some authors had scholarship or salary support and one author disclosed external grants and fees unrelated to the submitted work.
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more resources ](https://pubmed.ncbi.nlm.nih.gov/42281381/#linkout) Title & authors Abstract Conflict of interest statement Figures References MeSH terms Substances Grants and funding LinkOut - more resources Am J Epidemiol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Am+J+Epidemiol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Am+J+Epidemiol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42281381/) . 2026 Sep 3;195(9):2334-2346. doi: 10.1093/aje/kwag132. # Antibiotic treatment for non-specific upper respiratory tract infections and exacerbation risk in children with asthma: a target trial emulation study [Carmen Cañete Ramirez](https://pubmed.ncbi.nlm.nih.gov/?term=Ramirez+CC&cauthor_id=42281381)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-1 "Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-2 "Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada."), [Albina Tskhay](https://pubmed.ncbi.nlm.nih.gov/?term=Tskhay+A&cauthor_id=42281381)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-2 "Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-3 "Department of Family Medicine, McGill University, Montréal, QC, Canada."), [Ana C Blanchard](https://pubmed.ncbi.nlm.nih.gov/?term=Blanchard+AC&cauthor_id=42281381)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-2 "Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada."), [Amélie Forget](https://pubmed.ncbi.nlm.nih.gov/?term=Forget+A&cauthor_id=42281381)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-1 "Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada."), [Marie-Élaine Métras](https://pubmed.ncbi.nlm.nih.gov/?term=M%C3%A9tras+M%C3%89&cauthor_id=42281381)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-1 "Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-2 "Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada."), [Tibor Schuster](https://pubmed.ncbi.nlm.nih.gov/?term=Schuster+T&cauthor_id=42281381)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-3 "Department of Family Medicine, McGill University, Montréal, QC, Canada."), [Lucie Blais](https://pubmed.ncbi.nlm.nih.gov/?term=Blais+L&cauthor_id=42281381)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-1 "Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada."), [Cristina Longo](https://pubmed.ncbi.nlm.nih.gov/?term=Longo+C&cauthor_id=42281381)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-1 "Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#full-view-affiliation-2 "Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada.") Affiliations Expand ### Affiliations * 1 Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada. * 2 Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada. * 3 Department of Family Medicine, McGill University, Montréal, QC, Canada. * PMID: **42281381** * PMCID: [ PMC13537853 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13537853/) * DOI: [ 10.1093/aje/kwag132 ](https://doi.org/10.1093/aje/kwag132) Item in Clipboard # Antibiotic treatment for non-specific upper respiratory tract infections and exacerbation risk in children with asthma: a target trial emulation study Carmen Cañete Ramirez et al. Am J Epidemiol. 2026. Show details Display options Display options Format Abstract PubMed PMID Am J Epidemiol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Am+J+Epidemiol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Am+J+Epidemiol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42281381/) . 2026 Sep 3;195(9):2334-2346. doi: 10.1093/aje/kwag132. ### Authors [Carmen Cañete Ramirez](https://pubmed.ncbi.nlm.nih.gov/?term=Ramirez+CC&cauthor_id=42281381)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-1 "Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-2 "Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada."), [Albina Tskhay](https://pubmed.ncbi.nlm.nih.gov/?term=Tskhay+A&cauthor_id=42281381)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-2 "Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-3 "Department of Family Medicine, McGill University, Montréal, QC, Canada."), [Ana C Blanchard](https://pubmed.ncbi.nlm.nih.gov/?term=Blanchard+AC&cauthor_id=42281381)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-2 "Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada."), [Amélie Forget](https://pubmed.ncbi.nlm.nih.gov/?term=Forget+A&cauthor_id=42281381)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-1 "Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada."), [Marie-Élaine Métras](https://pubmed.ncbi.nlm.nih.gov/?term=M%C3%A9tras+M%C3%89&cauthor_id=42281381)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-1 "Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-2 "Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada."), [Tibor Schuster](https://pubmed.ncbi.nlm.nih.gov/?term=Schuster+T&cauthor_id=42281381)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-3 "Department of Family Medicine, McGill University, Montréal, QC, Canada."), [Lucie Blais](https://pubmed.ncbi.nlm.nih.gov/?term=Blais+L&cauthor_id=42281381)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-1 "Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada."), [Cristina Longo](https://pubmed.ncbi.nlm.nih.gov/?term=Longo+C&cauthor_id=42281381)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-1 "Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42281381/#short-view-affiliation-2 "Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada.") ### Affiliations * 1 Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada. * 2 Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada. * 3 Department of Family Medicine, McGill University, Montréal, QC, Canada. * PMID: **42281381** * PMCID: [ PMC13537853 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13537853/) * DOI: [ 10.1093/aje/kwag132 ](https://doi.org/10.1093/aje/kwag132) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract Antibiotics are often prescribed to children with asthma for non-specific upper respiratory tract infections (NS-URTIs), but their association with exacerbation risk in children with pre-existing asthma is unclear. We aimed to determine if antibiotics are associated with asthma exacerbation risk in the 6 months following NS-URTI resolution. Using Quebec administrative health and drug claims data, we emulated a series of target trials among children (0-17 years) with asthma visiting an outpatient physician for an NS-URTI. Treatment strategies were no, narrow-, or broad-spectrum antibiotics initiated within 3 days following the index visit. The primary outcome was exacerbation during the 6 months following an initial 10-day induction period, defined as oral corticosteroid use, emergency department visits, or hospitalizations for asthma. Risk ratios (RR) and differences (RDs) were estimated using inverse probability of treatment weighted log-binomial models. Among 13 646 children (24 139 person-trials), 8.8% and 11.4% received narrow- and broad-spectrum antibiotics, respectively. Compared with no antibiotics, narrow-spectrum antibiotics were associated with an RR of 1.26 (95%CI, 0.99-1.53; RD, 0.07%), while broad-spectrum antibiotics were associated with an RR of 1.28 (95%CI, 1.03-1.54; RD, 0.08%). Broad-spectrum antibiotics were associated with modestly higher exacerbation risks, although absolute RDs were small ( 2 doses), and type of provider (specialist vs. general practitioner). [ ![Figure 2](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9868/13537853/7a143f44ec2b/kwag132f2.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9868/13537853/cbf6657a1350/kwag132f2.webp) ** Figure 2 ** Flow chart defining the study… ** Figure 2 ** Flow chart defining the study population and included target trials. Flow diagram showing… **Figure 2** Flow chart defining the study population and included target trials. Flow diagram showing the application of exclusion criteria used to derive the analytic sample.* Specific upperrespiratory tract infections included pharyngitis, sinusitis, and tonsilitis. Lower respiratory tract infectionsincluded bronchiolitis and bronchitis. Other infections included urinary tract infections. [ ![Figure 3](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9868/13537853/ed1150f97413/kwag132f3.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9868/13537853/5264512210ab/kwag132f3.webp) ** Figure 3 ** Antibiotic exposure and asthma exacerbation… ** Figure 3 ** Antibiotic exposure and asthma exacerbation risk: subgroup effects in children with NS-URTI. The… **Figure 3** Antibiotic exposure and asthma exacerbation risk: subgroup effects in children with NS-URTI. The graph displays the Marginal Risk Ratio (mRR) with a 95% Confidence Interval (CI) comparing children exposed to spectrum-specific and class-specific antibioticsversus those unexposed, following a non-specific acute upper respiratory infection. The results arestratified into several subgroups, includin
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