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[Antibiotic prescribing patterns in primary health care. Do pediatricians use antibiotics rationally?]
C Calvo Rey1, R Albañil Ballesteros, M Y Sánchez Méndez
1Hospital Severo Ochoa, Leganés, Area 9, Madrid.
Insights
Antibiotic prescribing in children under four is often inappropriate, with 46% of antibiotic cycles being unnecessary or incorrect. Pediatricians in outpatient clinics made more appropriate decisions than emergency ward physicians.
Area of Science:
- Pediatric infectious disease
- Antimicrobial stewardship
- Primary healthcare research
Context:
- Antibiotic prescribing patterns in pediatric populations are crucial for effective treatment and antimicrobial stewardship.
- Understanding prescribing habits in primary healthcare settings is essential for identifying areas of improvement.
- The study focuses on children under four years old in Madrid's primary care centers.
Purpose:
- To analyze antibiotic prescribing patterns in pediatric patients (under 4 years) at a primary healthcare center.
- To evaluate the appropriateness of antibiotic therapy and drug selection for diagnosed pathologies.
- To identify variations in prescribing decisions among healthcare providers.
Summary:
- A retrospective study analyzed 910 children under four, evaluating 3,847 infectious/respiratory processes and prescribed antibiotic cycles.
- Sixty-three percent of children received at least one antibiotic cycle annually; 36% of processes involved antibiotic prescription.
- A significant 46% of antibiotic prescriptions were deemed inappropriate, either due to lack of necessity (71.6%) or incorrect drug choice (28.4%).
Impact:
- Findings indicate overprescription of antibiotics in pediatric patients, highlighting a need for intervention.
- Pediatricians in outpatient clinics demonstrated more appropriate prescribing decisions compared to emergency ward physicians.
- Amoxicillin and amoxicillin-clavulanic acid were the most frequently prescribed antibiotics, underscoring the need for guideline adherence.
Objectives:
To determine antibiotic prescribing patterns in the pediatric (infants and children) population attended to at a primary health care centre in the community of Madrid. We also wanted to determine the necessity or otherwise of antibiotic therapy and whether the selected antibiotic drug was appropriate for the pathology diagnosed.
Methods:
Retrospective study of all infectious or respiratory processes diagnosed during 1 year and of the respective antibiotic cycles prescribed in all patients under the age of 4 years. The prescribing physician and the appropriateness of all therapeutic decisions, including those where the decision was not to treat with antibiotic drugs, were analyzed.
Results:
We evaluated 910 children under the age of 4 years with a total of 3, 847 processes (mean of 4.55 +/-3.6 processes per child per year). Sixty-three percent of the children received at least one cycle of antibiotic drugs per year (mean 1.63+/-1.69 cycles of treatment per child per year). Of all therapeutic decisions, 85.2% were considered appropriate. In 36% of the processes antibiotics were prescribed (1,386 cycles), 46% of which were considered inappropriate either because no antibiotic therapy should have been given (71.6%) or because the chosen drug was not appropriate for the pathology (28.4%). There were significant differences among the evaluated physicians. The most correct decisions were taken by the pediatrician in the outpatient clinic, especially when compared with physicians in the emergency ward (p<0.0001). The most frequently prescribed antibiotic drugs were amoxicillin (41.2%) and amoxicillin combined with clavulanic acid (33%). Cephalosporin accounted only for 6.9% of the prescriptions.
Conclusions:
Antibiotic therapy is overprescribed in children, a situation that should be corrected.