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Antibiotic use for upper respiratory tract infections: how well do pediatric residents do?
Sumathi Nambiar1, Richard H Schwartz, Michael J Sheridan
1Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, VA, USA. nambiars@cder.fda.gov
Insights
Pediatric residents show limited awareness and compliance with guidelines for judicious antibiotic use in children with upper respiratory tract infections. Inappropriate antibiotic prescribing remains common, particularly among first-year residents.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Medical education
Background:
- Inappropriate antibiotic use for pediatric upper respiratory tract infections (URTIs) contributes to antibiotic resistance.
- Emerging antibiotic resistance is a significant global public health concern.
Purpose of the Study:
- To evaluate awareness and adherence to judicious antibiotic use principles for URTIs among pediatric residents.
- Assessed compliance with guidelines from the Centers for Disease Control and Prevention and the American Academy of Pediatrics.
Main Methods:
- A survey questionnaire was distributed to pediatric residents in the mid-Atlantic region of the United States.
- 74% of 524 surveyed residents completed the questionnaire, assessing knowledge and prescribing habits for URTIs.
Main Results:
- Awareness of judicious antibiotic use principles increased with resident training year (16% PL1, 36% PL2, 50% PL3/PL4).
- Inappropriate antibiotic prescribing for afebrile infants with purulent rhinorrhea decreased with training (29% PL1, 25% PL2, 15% PL3/PL4).
- Prescribing rates for febrile infants also showed a trend of decrease with training year.
Conclusions:
- Pediatric residents often lack awareness regarding judicious antibiotic use for URTIs.
- Inappropriate antibiotic prescribing for URTIs is prevalent, especially among junior residents.
- Training year positively correlates with improved awareness and appropriate prescribing practices.
Background:
Antibiotics are often used inappropriately for the treatment of upper respiratory tract infections in children, and the emergence of resistant bacteria is a growing public health concern.
Objective:
To assess awareness and compliance with the Centers for Disease Control and Prevention (Atlanta, Ga) and American Academy of Pediatrics (Elk Grove Village, Ill) principles for judicious antibiotic use for upper respiratory tract infections among residents from a sample of pediatric residency programs in the mid-Atlantic region of the United States.
Participants And Methods:
Residents at the participating programs were requested to complete a survey questionnaire.
Results:
Of the 524 pediatric residents surveyed, 74% (388 participants) completed the questionnaire. Familiarity with the principles increased with a year of training; 16%, 36%, and 50% of first-year (PL1), second-year (PL2), and third- or fourth-year (PL3/PL4) residents, respectively, had heard or read about the principles (chi(2)(trend); P<.001). In response to a direct question about the use of antibiotics for an otherwise well, afebrile 18-month-old child with purulent rhinorrhea, 29%, 25%, and 15% of PL1, PL2, and PL3/PL4 residents, respectively, would prescribe antibiotics within 10 days of onset of illness (chi(2)(trend); P =.008). A significant difference was found between PL1 vs PL3/PL4 participants (difference = 20%; 95% CI = 3%-26%). If the same infant had a temperature of 38.8 degrees C, then 63%, 45%, and 47% of PL1, PL2, and PL3/PL4 residents, respectively, would prescribe antibiotics (chi(2)(trend); P =.008).
Conclusions:
Awareness among pediatric residents about the judicious use of antibiotics for upper respiratory tract infections is often lacking, and inappropriate use of antibiotics for this condition continues to be prevalent. This was especially noted among PL1 residents, with an improving trend noted with increasing years of training.