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Prospective study of antibiotic prescribing for children
1Department of Pathology, McMaster University Faculty of Health Sciences, Hamilton, Ont. rpennie@mcmaster.ca
Insights
Pediatric antibiotic prescribing is high for acute respiratory infections, particularly acute otitis media. Reducing antibiotic use requires more selective prescribing for common conditions like otitis media, pharyngitis, and bronchitis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic resistance is a growing global health concern.
- Appropriate antibiotic use in pediatric primary care is crucial for combating resistance.
- Understanding prescribing patterns is essential for targeted interventions.
Purpose of the Study:
- To determine the frequency and indications for antibiotic prescriptions in children.
- To compare antibiotic prescribing practices among family physicians, pediatricians, and urgent care physicians.
- To identify areas for improvement in antibiotic stewardship.
Main Methods:
- Prospective observational study in ten primary care offices in Ontario.
- Data collected over a 3-week period in February-March 1997.
- Included children under 16 years presenting with various conditions.
Main Results:
- Over 4300 visits were observed, with 1706 antibiotic prescriptions issued.
- Acute respiratory infections accounted for 92% of prescriptions, with acute otitis media being the most common diagnosis (53%).
- Urgent care physicians were more likely to prescribe antibiotics immediately and deviate from guidelines for acute otitis media.
Conclusions:
- Acute otitis media, pharyngitis, and bronchitis drive 82% of pediatric antibiotic prescriptions.
- Physicians need to be more judicious in prescribing antibiotics for these common conditions.
- Reducing antibiotic use necessitates changes in managing suspected acute otitis media.
Objectives:
To observe the frequency with which children in outpatient primary care settings are prescribed antibiotics and to investigate why these antibiotics are prescribed. To compare the prescribing behaviour of family doctors, primary care pediatricians, and urgent care physicians and to determine where refinements in management are most needed to reduce the number of antibiotic prescriptions appropriately.
Design:
Prospective study using a data entry form with mostly closed-ended questions.
Setting:
Ten primary care offices in urban south-central and eastern Ontario: five family practices, three pediatric practices, and two urgent care centres (UCC).
Participants:
Every child younger than 16 years visiting these offices during a 3-week period in February and March 1997.
Main Outcome Measures:
Frequency, clinical indications, and nature of the antibiotics prescribed.
Results:
There were 4344 observed visits. Of 1706 antibiotic prescriptions, 1481 were for 10 days, and 1577 (92%) were for acute respiratory infections, 920 (53%) specifically for acute otitis media (AOM). Full courses of antibiotics were given immediately (i.e., without test results) to 321 (76%) of 425 children with pharyngitis. Antibiotics were prescribed for 145 (90%) of 163 children with bronchitis. Urgent care physicians were significantly more likely than pediatricians or family physicians to prescribe immediate antibiotics and to disregard guidelines when choosing antibiotics for uncomplicated AOM.
Conclusions:
Three diagnoses accounted for 82% of antibiotic prescriptions: AOM, pharyngitis, and bronchitis. Physicians should be more selective when deciding whether, and for how long, to prescribe antibiotics for those three common conditions. Substantial reductions in antibiotic use will require changes in how physicians manage suspected AOM, the most common indication for antibiotics.