Related Experiment Videos
Outcomes after judicious antibiotic use for respiratory tract infections seen in a private pediatric practice
M E Pichichero1, J L Green, A B Francis
1Elmwood Pediatric Group, Department of Microbiology/Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA. mepo@uhura.cc.rochester.edu
Insights
In children with respiratory tract infections (RTIs), antibiotics are often unnecessary. Judicious antibiotic use in pediatric practice did not increase return visits or subsequent bacterial infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Most childhood respiratory tract infections (RTIs) are viral and self-limiting, often not requiring antibiotic treatment.
- Antibiotic overuse contributes to resistance and adverse effects, necessitating judicious prescribing practices.
Purpose of the Study:
- To evaluate the safety and efficacy of judicious antibiotic use in pediatric private practice for RTIs.
- To determine if withholding antibiotics for viral RTIs increases return office visits or secondary bacterial infections.
Main Methods:
- Prospective 12-month study involving children with acute respiratory tract illness.
- Viral cultures performed on all patients; follow-up for 30 days to assess outcomes.
- Antibiotics prescribed only for presumed or documented bacterial infections.
Main Results:
- Out of 383 children, 77% did not receive antibiotics initially.
- Children not receiving antibiotics had similar rates of unscheduled return visits (29%) compared to those who did (44%).
- No increase in bacterial infections was observed in children managed without antibiotics.
Conclusions:
- Children with RTIs lacking evidence of bacterial infection do not require antibiotics.
- Judicious antibiotic stewardship in pediatric practice is effective and safe for managing RTIs.
- This approach reduces unnecessary antibiotic exposure without compromising patient outcomes.
Background:
Most respiratory tract infections (RTIs) in children have a viral cause, they resolve on their own, and antibiotics need not be prescribed.
Objective:
We sought to provide evidence that judicious antibiotic use can be accomplished in private pediatric practice without observing an increase in return office visits or in the rate of bacterial infections that may follow.
Study Design:
This was a prospective 12-month study from July 1, 1996 through June 30, 1997. On the same 1 day each week, a representative convenience sample of acute respiratory tract illness patients was enrolled, and laboratory studies performed as appropriate, including viral cultures on all. Children were then followed for 30 days to ascertain the outcomes of not prescribing antibiotics except when specific bacterial infections were present at the initial visit.
Results:
Three hundred eighty-three children were enrolled; 293 (77%) did not receive antibiotics at the enrollment visit. Ninety children (23%) received antibiotics based on a diagnosis of acute otitis media (n = 53), acute streptococcal tonsillopharyngitis (n = 18), or other presumed or documented bacterial infections (n = 19). An unscheduled return visit related to the initial visit occurred for 86 (29%) of the 293 children not receiving antibiotics initially and in 40 (44%) of 90 children receiving antibiotics initially. Eighty-seven children (23%) had positive viral culture results. The most frequently isolated viruses were adenovirus, enterovirus, parainfluenzae virus, and influenza virus.
Conclusion:
Children with RTIs without a concomitant presumed or proven bacterial infection do not require antibiotics. In this busy office practice, >75% of the children presenting with an RTI did not have a presumed or proven bacterial infection. These children did not have a higher rate of return office visits or an increase in bacterial infections. This reinforces the judicious use of antibiotics in managing children with RTIs.outcomes, antibiotic, respiratory infections.