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Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis
A C Nyquist1, R Gonzales, J F Steiner
1Department of Pediatrics, University of Colorado Health Sciences Center, Denver 80262, USA.
Insights
Antibiotic prescribing for common childhood illnesses like colds and bronchitis is widespread in the US. This study highlights significant antibiotic use in pediatric care for conditions often not requiring such treatment.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Public health surveillance
Background:
- Antibiotic resistance is a growing global health concern linked to antibiotic use.
- Children are a key demographic for antibiotic prescriptions, making them a focus for reducing unnecessary use.
Purpose of the Study:
- To analyze antibiotic prescribing patterns for children under 18 diagnosed with colds, upper respiratory infections (URIs), or bronchitis in the US.
- To identify trends and potential areas for intervention in pediatric antibiotic prescribing.
Main Methods:
- Utilized data from the 1992 National Ambulatory Medical Care Survey, a representative national survey of practicing physicians.
- Included office-based physician practices and physician-completed patient record forms for patients under 18.
- Focused on principal diagnoses and antibiotic prescriptions as the main outcome measures.
Main Results:
- Antibiotics were prescribed in 44% of common cold, 46% of URI, and 75% of bronchitis cases in children.
- An estimated 6.5 million prescriptions for URIs/colds and 4.7 million for bronchitis were issued to children annually.
- Antibiotic use was higher in children aged 5-11 and lower when treated by pediatricians compared to non-pediatricians.
Conclusions:
- A substantial percentage of annual antibiotic prescriptions for children in the US are for conditions like colds, URIs, and bronchitis, which often do not require antibiotics.
- Findings underscore the need for improved antibiotic stewardship in pediatric care to combat resistance.
Context:
The spread of antibiotic-resistant bacteria is associated with antibiotic use. Children receive a significant proportion of the antibiotics prescribed each year and represent an important target group for efforts aimed at reducing unnecessary antibiotic use.
Objective:
To evaluate antibiotic-prescribing practices for children younger than 18 years who had received a diagnosis of cold, upper respiratory tract infection (URI), or bronchitis in the United States.
Design:
Representative national survey of practicing physicians participating in the National Ambulatory Medical Care Survey conducted in 1992 with a response rate of 73%.
Setting:
Office-based physician practices.
Participants:
Physicians completing patient record forms for patients younger than 18 years.
Main Outcome Measures:
Principal diagnoses and antibiotic prescriptions.
Results:
A total of 531 pediatric office visits were recorded that included a principal diagnosis of cold, URI, or bronchitis. Antibiotics were prescribed to 44% of patients with common colds, 46% with URIs, and 75% with bronchitis. Extrapolating to the United States, 6.5 million prescriptions (12% of all prescriptions for children) were written for children diagnosed as having a URI or nasopharyngitis (common cold), and 4.7 million (9% of all prescriptions for children) were written for children diagnosed as having bronchitis. After controlling for confounding factors, antibiotics were prescribed more often for children aged 5 to 11 years than for younger children (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.13-3.33) and rates were lower for pediatricians than for nonpediatricians (OR, 0.57; 95% CI, 0.35-0.92). Children aged 0 to 4 years received 53% of all antibiotic prescriptions, and otitis media was the most frequent diagnosis for which antibiotics were prescribed (30% of all prescriptions).
Conclusions:
Antibiotic prescribing for children diagnosed as having colds, URIs, and bronchitis, conditions that typically do not benefit from antibiotics, represents a substantial proportion of total antibiotic prescriptions to children in the United States each year.