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A Cross-Sectional Study of Antibiotic Prescribing for Childhood Upper Respiratory Tract Infections in Irish General
F Maguire1, M E Murphy2, M Rourke3
1School of Medicine, Trinity College Dublin, The University of Dublin, Ireland
Insights
Free General Practice (GP) care reduced antibiotic prescribing for children's upper respiratory tract infections (URTIs) by 50%. However, antibiotic use remains high in out-of-hours settings, highlighting the need for antimicrobial stewardship.
Area of Science:
- Pediatrics
- General Practice
- Infectious Disease Epidemiology
Background:
- Antibiotic prescribing for pediatric upper respiratory tract infections (URTIs) is a significant public health concern.
- Recent policy changes in Ireland introduced free General Practice (GP) care for children under 6, potentially influencing healthcare-seeking behaviors and prescribing patterns.
Purpose of the Study:
- To analyze antibiotic prescribing trends for URTIs in children under 6 years in Irish GP services before and after the introduction of free GP care.
- To identify factors associated with antibiotic prescription and adherence to preferred antibiotic guidelines.
Main Methods:
- A cross-sectional study analyzed data from 1,007 children under 6 presenting with URTIs over a two-week period across three years (2015-2017).
- Multivariate logistic regression was used to examine factors influencing antibiotic prescription and preferred antibiotic compliance.
Main Results:
- Following the introduction of free GP care, antibiotic prescriptions for pediatric URTIs decreased by 50%.
- Overall prescribing rates dropped from 70% to 50% in daytime GP services and from 72% to 60% in out-of-hours services.
- Out-of-hours services showed higher antibiotic prescription rates (OR: 1.42) and lower rates of deferred prescriptions (OR: 0.53).
Conclusions:
- The implementation of free GP care significantly reduced antibiotic prescribing for pediatric URTIs, possibly due to altered parental healthcare-seeking behaviors.
- Antibiotic prescribing remains more prevalent in out-of-hours settings and continues to be high by international standards.
- Enhanced antimicrobial stewardship efforts are crucial, particularly within the out-of-hours GP setting.
Abstract:
Introduction This study aimed to analyse antibiotic prescribing in cases of upper respiratory tract infection (URTI) in children under 6 years attending Irish daytime and out-of-hours General Practice (GP) services. There have been large scale changes in entitlements for free GP care for this group in recent years. Methods A cross-sectional study of children under 6 years with URTI presentations was performed, over a two-week period for three years from 2015 to 2017. Factors associated with antibiotic prescription and preferred antibiotic compliance were examined using multivariate logistic regression. Results 1,007 Under-6 patients presented with an URTI in our sample over the study period. Following introduction of free GP care, patients were 50% less likely to receive an antibiotic prescription. Overall antibiotic prescribing fell from 70% to 50% in daytime services and from 72% to 60% in the out-of-hours setting. Patients presenting to out-of-hours services were more likely to receive an antibiotic (OR: 1.42) and less likely to receive a deferred antibiotic (OR: 0.53). One quarter to one third of all prescriptions were for deferred antibiotics. Year-on-year trends showed a 13% decrease in prescriptions and 13% increase in preferred antibiotic use. Conclusion The introduction of free GP care led to significant reductions in antibiotic prescribing, which may be due to changes in health seeking behaviour by parents or other reasons. Antibiotic prescribing was more commonplace in the out-of-hours setting, and rates remains high by international standards. This study underlines the importance of ongoing work around GP antimicrobial stewardship, particularly in the out-of-hours setting.
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