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Bacterial prevalence and antimicrobial prescribing trends for acute respiratory tract infections
Matthew P Kronman1, Chuan Zhou2, Rita Mangione-Smith2
1Divisions of Infectious Diseases and Centers for Clinical and Translational Research and matthew.kronman@seattlechildrens.org.
Background And Objectives:
Antimicrobials are frequently prescribed for acute respiratory tract infections (ARTI), although many are viral. We aimed to determine bacterial prevalence rates for 5 common childhood ARTI - acute otitis media (AOM), sinusitis, bronchitis, upper respiratory tract infection, and pharyngitis- and to compare these rates to nationally representative antimicrobial prescription rates for these ARTI.
Methods:
We performed (1) a meta-analysis of English language pediatric studies published between 2000 and 2011 in Medline, Embase, and the Cochrane library to determine ARTI bacterial prevalence rates; and (2) a retrospective cohort analysis of children age <18 years evaluated in ambulatory clinics sampled by the 2000-2010 National Ambulatory Medical Care Survey (NAMCS) to determine estimated US ARTI antimicrobial prescribing rates.
Results:
From the meta-analysis, the AOM bacterial prevalence was 64.7% (95% confidence interval [CI], 50.5%-77.7%); Streptococcus pyogenes prevalence during pharyngitis was 20.2% (95% CI, 15.9%-25.2%). No URI or bronchitis studies met inclusion criteria, and 1 sinusitis study met inclusion criteria, identifying bacteria in 78% of subjects. Based on these condition-specific bacterial prevalence rates, the expected antimicrobial rescribing rate for ARTI overall was 27.4% (95% CI, 26.5%-28.3%). However, antimicrobial agents were prescribed in NAMCS during 56.9% (95% CI, 50.8%-63.1%) of ARTI encounters, representing an estimated 11.4 million potentially preventable antimicrobial prescriptions annually.
Conclusions:
An estimated 27.4% of US children who have ARTI have bacterial illness in the post-pneumococcal conjugate vaccine era. Antimicrobials are prescribed almost twice as often as expected during outpatient ARTI visits, representing an important target for ongoing antimicrobial stewardship interventions.
Insights
Antimicrobial prescribing for childhood acute respiratory tract infections (ARTI) in the US is nearly double the rate of bacterial infections. This highlights a significant opportunity for antimicrobial stewardship to reduce unnecessary prescriptions for these common illnesses.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial resistance
- Public health
Background:
- Antimicrobials are often prescribed for acute respiratory tract infections (ARTI), despite many being viral in origin.
- Determining bacterial prevalence in common childhood ARTI is crucial for appropriate treatment.
- The post-pneumococcal conjugate vaccine era necessitates updated understanding of bacterial ARTI rates.
Purpose of the Study:
- To ascertain bacterial prevalence rates for five common pediatric ARTI: acute otitis media (AOM), sinusitis, bronchitis, upper respiratory tract infection (URTI), and pharyngitis.
- To compare these bacterial prevalence rates with national antimicrobial prescription patterns for these conditions.
- To identify potential targets for antimicrobial stewardship interventions.
Main Methods:
- A meta-analysis of pediatric studies (2000-2011) was conducted to determine bacterial prevalence in ARTI.
- A retrospective cohort analysis of the National Ambulatory Medical Care Survey (NAMCS) (2000-2010) was used to assess US antimicrobial prescribing rates for ARTI in children.
- Data synthesis involved combining meta-analysis findings with national survey data.
Main Results:
- Bacterial prevalence was 64.7% for AOM and 20.2% for Streptococcus pyogenes in pharyngitis. Limited data were available for URTI, bronchitis, and sinusitis.
- The expected antimicrobial prescription rate based on bacterial prevalence was 27.4%.
- Antimicrobials were prescribed in 56.9% of ARTI encounters, resulting in an estimated 11.4 million potentially unnecessary annual prescriptions.
Conclusions:
- Approximately 27.4% of pediatric ARTI cases in the US are bacterial in the post-pneumococcal conjugate vaccine era.
- Antimicrobial prescribing for outpatient ARTI is nearly double the rate indicated by bacterial prevalence.
- Reducing unnecessary antimicrobial prescriptions for ARTI is a key target for antimicrobial stewardship programs.
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