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Respiratory Tract Infection Management and Antibiotic Prescription in Children: A Unique Study Comparing Three Levels
Koen J van Aerde1,2,3, Liza de Haan4, Mattijn van Leur4
1From the Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital.
Insights
Antibiotic prescribing for pediatric respiratory tract infections (RTIs) was similar across primary, secondary, and tertiary care. National guidelines for RTI management need better implementation to improve antibiotic stewardship.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Respiratory tract infections (RTIs) are a frequent reason for pediatric consultations in primary and emergency care.
- Feverish children with RTIs present a common clinical challenge for healthcare providers.
- Understanding antibiotic prescribing patterns is crucial for combating antimicrobial resistance.
Purpose of the Study:
- To investigate and compare antibiotic prescription rates for children with RTIs across different healthcare settings.
- To evaluate adherence to national guidelines in the management of pediatric RTIs.
- To identify areas for improvement in antibiotic stewardship for RTIs in children.
Main Methods:
- Prospective observational study conducted in Nijmegen, The Netherlands, in 2017.
- Inclusion of children with febrile illness and RTIs across primary (GP), secondary (general hospital), and tertiary (university hospital) care.
- Analysis of antibiotic prescription data for 892 cases without complex comorbidities.
Main Results:
- Overall antibiotic prescription rate for RTIs was 29%, with no significant differences between the three healthcare levels.
- Primary care accounted for the majority of annual antibiotic prescriptions for pediatric RTIs.
- Prescription rates for otitis media were consistently high (60%) across all settings; lower RTI rates varied (19-55%).
Conclusions:
- Antibiotic prescribing for pediatric RTIs is similar across primary, secondary, and tertiary care, with a disproportionate volume from primary care.
- Current prescription rates for RTIs exceed national guideline recommendations.
- Enhanced antibiotic stewardship and guideline implementation are necessary at all healthcare levels, particularly for hospital settings.
Background:
Respiratory tract infections (RTIs) are common in children with febrile illness visiting the general practitioner (GP) or emergency department. We studied the management of children with fever and RTI at 3 different levels of healthcare in The Netherlands, focusing on antibiotic prescription.
Methods:
This prospective observational study is part of the Management and Outcome of Febrile children in Europe study. Data were used from face-to-face patient contacts of children with febrile illness in three healthcare settings in Nijmegen, The Netherlands during 2017. These settings were primary (GP), secondary (general hospital) and tertiary care (university hospital).
Results:
Of 892 cases with RTI without complex comorbidities, overall antibiotic prescription rates were 29% with no differences between the 3 levels of healthcare, leading to an absolute number of 5031 prescriptions per 100,000 children per year in primary care compared with 146 in secondary and tertiary care combined. The prescription rate in otitis media was similar in all levels: 60%. In cases with lower RTI who received nebulizations prescription rates varied between 19% and 55%.
Conclusions:
Antibiotic prescription rates for RTIs in children were comparable between the 3 levels of healthcare, thus leading to a majority of antibiotics being prescribed in primary care. Relatively high prescription rates for all foci of RTIs were found, which was not in agreement with the national guidelines. Antibiotic stewardship needs improvement at all 3 levels of healthcare. Guidelines to prescribe small spectrum antibiotics for RTIs need to be better implemented in hospital care settings.
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