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Dyspnea in Children as a Symptom of Acute Respiratory Tract Infections and Antibiotic Prescribing
Valentina Risteska-Nejashmikj1, Snezhana Stojkovska2, Katarina Stavrikj1
1Center for Family Medicine, Faculty of Medicine, Skopje, Republic of Macedonia.
Insights
Pediatric antibiotic prescriptions for acute respiratory infections (ARI) with dyspnea in Macedonia are excessively high at 54.6%. This study highlights inappropriate antibiotic use in children, emphasizing the need for better adherence to evidence-based medicine.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Dyspnea, or difficulty breathing, is a common symptom in children with acute respiratory infections (ARI).
- Family physicians play a crucial role in recognizing, triaging, and managing pediatric dyspnea, with a focus on symptom management over antibiotic prescription.
- Current practices show unnecessary hospitalizations and frequent antibiotic use in children with ARI, contrary to guidelines recommending lower prescription rates.
Purpose of the Study:
- To assess antibiotic (AB) prescription rates by primary care physicians in Macedonia for children diagnosed with ARI and dyspnea.
- To evaluate the appropriateness of antibiotic prescribing in pediatric ARI cases within the Macedonian healthcare system.
Main Methods:
- Data from a national project on antibiotic prescribing for ARI, conducted in November 2014, were analyzed.
- Eighty-six general practitioners in Macedonia participated, analyzing a cohort of 3026 children aged 0-5 years presenting with dyspnea.
- Antibiotic prescription rates and types of antibiotics used were recorded.
Main Results:
- A high rate of 54.6% antibiotic prescriptions was observed for children with dyspnea.
- Amoxicillin plus clavulanic acid was the most frequently prescribed antibiotic.
- The majority of children (57.7%) were diagnosed with upper ARI, yet received antibiotics.
Conclusions:
- There is an increased and inappropriate prescription of antibiotics for children with ARI presenting with dyspnea in Macedonia.
- Factors influencing prescribing include parental perceptions, fear, and a lack of adherence to evidence-based medicine (EBM).
- Interventions are needed to improve antibiotic stewardship in pediatric respiratory infections.
Background:
Dyspnea is an unpleasant feeling of breathing difficulty, shortness of breath and inability to satisfy the hunger for air. The role of family physicians is to be prepared to recognise dyspnea as a symptom of acute respiratory infections (ARI), to perform triage and managing of children with acute dyspnea and make continuous education of parents. In the treatment of acute dyspnea more important is to treat dyspnea as a symptom than the prescribing of antibiotics (AB). Nowadays, even more often large amount of children, because of the noncompliance in the treatment and the pressure from the parents, unnecessary is hospitalised and frequently used antibiotics: According to the guidelines, a small percentage of children with ARI should be treated with AB. The rate of antibiotic prescription should be around 15-20% and lower.
Aim:
To assess doctor's AB prescriptions in Primary care practices in Macedonia, for ARI and dyspnea in children we use the data from a National project about antibiotic prescribing for acute respiratory tract infections, which has been run in 2014 November as a part of E - quality program.
Methods:
Eighty-six general practitioners from Macedonia have taken participation in it. The group of 3026 children, from 0-5 years of age, with symptoms of dyspnea, was analysed. We have found a rate of 54.6% antibiotic prescriptions (AB). From 3026 children with dyspnea, AB got 1519 children, 852 of which were prescribed by a specialist.
Results:
The children were mostly diagnosed with upper ARI, in 57.7%. The most used AB is amoxicillin + clavulonic acid. We concluded that there was an increased and inappropriate prescribing of antibiotics in children with ARI, presented with dyspnea in Macedonia.
Conclusion:
Perceptions and the parent's attitudes do not correlate with the severity of clinical picture of the disease in children and lack of use Evidence-based medicine (EBM), insecurity, fear, loss of patients effect on antibiotic prescribing of the doctors.
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