Antibiotic choices by paediatric residents and recently graduated paediatricians for typical infectious disease
Katharine Smart1, Jean-Francois Lemay, James D Kellner
1Pediatric Emergency Medicine.
Insights
Paediatric residents and recent graduates generally made appropriate antibiotic choices for common infections. However, treatment durations varied significantly, and some unnecessarily recommended broad-spectrum antibiotics.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic stewardship is crucial in pediatric infectious disease management.
- Variability in clinical practice among trainees and early-career physicians can impact patient outcomes.
- Published guidelines provide a framework for antibiotic selection and duration, but adherence may vary.
Purpose of the Study:
- To assess antibiotic prescribing practices and duration recommendations by pediatric residents and recent graduates.
- To identify potential discrepancies between recommended practices and established guidelines for common pediatric infections.
- To evaluate the consistency of treatment duration recommendations across different infectious disease scenarios.
Main Methods:
- A questionnaire-based survey was distributed to pediatric residents and recent graduates across Canada.
- Participants were presented with 10 typical pediatric infectious disease scenarios.
- The survey focused on initial antibiotic selection and recommended duration of therapy for each scenario.
Main Results:
- High concordance (≥85%) in antibiotic recommendations for most scenarios, with exceptions noted for otitis media, sinusitis, cellulitis, and fever/neutropenia.
- Significant variability in recommended treatment durations, with twofold or greater differences across all scenarios and threefold or greater for sinusitis, meningitis, and osteomyelitis.
- Paediatric residents were more inclined to use broader-spectrum cephalosporins for pneumococcal pneumonia and shorter treatment durations for sinusitis compared to recent graduates.
Conclusions:
- Paediatric residents and recent graduates generally provided reasonable antibiotic recommendations aligned with guidelines for most common pediatric infections.
- A notable minority of participants recommended unnecessarily broad-spectrum antibiotics for certain conditions.
- The substantial variation in recommended treatment durations highlights a lack of definitive evidence for many conditions and underscores areas for further guideline development and education.
Objective:
To evaluate antibiotic choices and recommendations for duration of therapy made by paediatric residents (PRs) and recently graduated paediatricians (RGPs) in several typical infectious disease conditions.
Methods:
In autumn 2002, a two-page questionnaire was sent to 276 core PRs in Canadian residency programs and to a random selection of 276 RGPs from across Canada. The questionnaire described 10 scenarios: otitis media, pharyngitis, sinusitis, bronchopneumonia, lobar pneumonia, meningitis, pyelonephritis, osteomyelitis, cellulitis, and fever and neutropenia. The participants were asked primarily about initial antibiotic selection and duration of treatment for each scenario.
Results:
There were 251 participants (overall response rate of 45%). The two most common antibiotic recommendations constituted 85% or more of the total for all scenarios except acute otitis media, sinusitis, cellulitis, and fever and neutropenia. There was a twofold or more difference in the range of recommended duration of treatment for all scenarios and a threefold or more difference for sinusitis, meningitis and osteomyelitis. PRs were more likely than RGPs to use broader spectrum cephalosporins for pneumococcal pneumonia (33% versus 15%, respectively; P=0.001) and to treat sinusitis for just five to 10 days (39% versus 22%, respectively; P=0.01). Also, 33% of all participants recommended amoxicillin/clavulanate or a cephalosporin rather than amoxicillin for sinusitis.
Conclusion:
PRs and RGPs made similar and reasonable recommendations, largely in line with published guidelines, for most of the infectious disease scenarios presented. For some conditions, a significant minority of respondents unnecessarily recommended broad-spectrum antibiotics. The most variable responses were for duration of treatment, reflecting the lack of certainty in the published evidence base for many conditions.
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