Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections
David R Nash1, Jeffrey Harman, Ellen R Wald
1Department of Pediatrics, University of Pittsburgh School of Medicine, PA 15213, USA. david.nash@chp.edu
Insights
Physician antibiotic prescribing for pediatric respiratory infections shows slow improvement. Despite reduced inappropriate antibiotic use, nearly half of children with upper respiratory infections still receive unnecessary antibiotics.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Public Health
Background:
- Antibiotic resistance is a growing global health concern.
- Inappropriate antibiotic use for viral infections contributes to resistance.
- Pediatric respiratory infections are frequently treated with antibiotics.
Purpose of the Study:
- To evaluate trends in appropriate antibiotic prescribing for common pediatric respiratory conditions.
- To identify factors associated with inappropriate antibiotic use in children.
Main Methods:
- Analysis of the National Ambulatory Medical Care Survey data from 1995-1998.
- Inclusion of pediatric patients (<18 years) seen by primary care physicians.
- Multivariate analyses to assess prescribing patterns for bronchitis, upper respiratory tract infections, sinusitis, otitis media, and pharyngitis.
Main Results:
- A significant decrease in antibiotic prescribing for upper respiratory tract infections was observed between 1995 and 1998.
- Children diagnosed with sinusitis or otitis media were less likely to receive suboptimal antibiotic therapy in 1998 compared to 1995.
- Despite improvements, nearly 50% of upper respiratory tract infection cases still received antibiotics.
Conclusions:
- Physician antibiotic prescribing patterns for pediatric respiratory infections are gradually improving.
- The overall use of inappropriate antibiotics remains a significant issue.
- Further interventions are needed to optimize antibiotic use in pediatric primary care.
Objectives:
To determine if the rate of appropriate antibiotic use in the treatment of children with bronchitis, viral upper respiratory tract infections, sinusitis, otitis media, and pharyngitis has changed in recent years and to identify factors that are associated with the use of inappropriate antibiotic therapy.
Design:
The National Ambulatory Medical Care Survey was used to examine the antimicrobial prescribing habits of physicians who provide primary care for children. Data were analyzed from 1995-1998.
Setting:
Office-based physician practices.
Participants:
Pediatricians, family physicians, and generalists completing survey forms for patients younger than 18 years.
Main Outcome Measure:
The appropriate use of antibiotics for upper respiratory tract infections.
Results:
Multivariate analyses were used to examine factors associated with the use of inappropriate antibiotics to treat either upper respiratory tract infections or bronchitis. Patients seen in 1998 and diagnosed as having upper respiratory tract infections were 0.69 (95% confidence interval, 0.59-0.81) times less likely to be treated with antibiotics compared with patients seen in 1995. Multivariate analyses were also used to assess factors associated with the use of antibiotics with a suboptimal therapeutic profile for the treatment of either sinusitis or otitis media. Children diagnosed as having either sinusitis or otitis media were 0.3 (95% confidence interval [CI], 0.16-0.48) times less likely to receive antibiotics with a suboptimal therapeutic effect in 1998 compared with 1995.
Conclusions:
Physicians are slowly improving their antibiotic prescribing patterns but the use of inappropriate antibiotics is still common. Almost half of patients with upper respiratory tract infections receive antibiotics.
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