Antibiotic Prescribing for Children With Colds, Upper Respiratory Tract Infections, and Bronchitis

Nyquist, Ann‐Christine; Gonzales, Ralph; Steiner, John F.; Sande, Merle A.

doi:10.1001/jama.279.11.875

Cited by 591 publications

(430 citation statements)

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“…In studies of antibiotic prescriptions, family physicians were also more likely to prescribe medications. 26,27 There are important distinctions between family physicians and pediatricians that must be considered as research continues in this area. However, until evidence and guidelines provide standards for appropriate SSRI use and better measures of patient outcomes in mental health are developed, terms such as underuse and overuse will be difficult to operationalize.…”

Section: Discussionmentioning

confidence: 99%

Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

2000

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ABSTRACT. Objectives. Selective serotonin reuptake inhibitor (SSRI) prescriptions for children and adolescents have increased greatly in recent years despite a paucity of demonstrated safety and efficacy data and a lack of clear guidelines for use. Our study sought to describe family physician and pediatrician SSRI prescribing patterns for children and adolescents, identify influences on SSRI prescription variations, and describe the use of SSRI within the overall management of depression and other mental disorders in primary care.Design. A survey was mailed to all 596 active North Carolina general pediatricians and a random sample of 557 family physicians in primary care practice. Family physicians who did not see children in their practice were excluded. The survey instrument consisted of a 4-page questionnaire. Survey items included physician demographics, practice characteristics, general management, volume of pediatric patients with depressive symptoms, prescription of SSRIs for depression and other diagnoses, and potential influences on SSRI prescribing practices. The main outcomes were self-reported physician prescription of SSRIs for children and adolescents. Results were analyzed using 2 comparisons and logistic regression.Results. The overall response rate was 66% (55% family physicians and 76% pediatricians). Of the physicians, 72% had prescribed an SSRI for a child or adolescent. Depression was the most common reason for prescribing an SSRI; over two thirds of respondents had prescribed an SSRI for depression in a child 18 years of age or younger. Over half of the physicians reported they had prescribed an SSRI for a diagnosis other than depression in a child 18 years of age or younger. Attention-deficit/ hyperactivity disorder was the most frequent use cited other than depression, followed by obsessive-compulsive disorder, aggression, eating disorders, and enuresis.Primary care physicians prescribed SSRIs for adolescents more commonly than for younger children. Only 6% of the respondents had ever prescribed an SSRI for a child younger than 6 years of age. In terms of SSRI prescriptions written for depression in the last 6 months, 32% of the physicians had recently prescribed SSRIs for adolescent patients and 6% for patients younger than 12 years of age. Family physicians were more likely than pediatricians to have recently prescribed SSRIs for adolescent patients (41% vs 26%), but there was no difference in recent SSRI prescriptions for children <12 years of age by physician specialty (4% vs 6%).Prescription of SSRIs was not associated with decreased use of counseling for treatment of depression, but prescription of SSRIs was associated with decreased use of referrals (63% vs 74%). There was no difference in the use of counseling between family physicians and pediatricians (61% vs 59%). However, pediatricians were more likely to use referrals in their usual approach to depression (77% vs 48%) compared with family physicians.More family physicians had prescribed SSRIs for pediatric patients compared ...

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Section: Discussionmentioning

confidence: 99%

Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

2000

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“…6 Ciofi degli Atti et al e Nyquist et al found out that more than 40% of the paediatric patients visited by doctors for respiratory infections receive an antibiotic. 7,8 Moreover, a recent study conducted by Adam et al …”

Section: Introductionmentioning

confidence: 99%

Knowledge and attitudes towards the use of antibiotics in the paediatric age group: a multicenter survey in Italy

Bert

Gualano

Gili

et al. 2016

Eur J Public Health

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“…1,2 The rapid increase in resistance among common bacterial pathogens, such as Streptococcus pneumoniae, [3][4][5][6] is widely believed to be fueled by high rates of antibiotic use, much of which is unnecessary. [7][8][9][10][11] Because of the communicability of bacterial pathogens, the consequences of resis-tance have an impact on communities in addition to individual carriers. Young children have had the highest antibiotic-use rates of any age group 12 and may be at particular risk for acquiring and spreading resistant organisms, especially in group settings such as child care.…”

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confidence: 99%

Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts

et al. 2008

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OBJECTIVES. Reducing unnecessary antibiotic use, particularly among children, continues to be a public health priority. Previous intervention studies have been limited by size or design and have shown mixed results. The objective of this study was to determine the impact of a multifaceted, community-wide intervention on overall antibiotic use for young children and on use of broad-spectrum agents. In addition, we sought to compare the intervention's impact on commercially and Medicaid-insured children. METHODS. We conducted a controlled, community-level, cluster-randomized trial in 16 nonoverlapping Massachusetts communities, studied from 1998 to 2003. During 3 years, we implemented a physician behavior-change strategy that included guideline dissemination, small-group education, frequent updates and educational materials, and prescribing feedback. Parents received educational materials by mail and in primary care practices, pharmacies, and child care settings. Using health-plan data, we measured changes in antibiotics dispensed per person-year of observation among children who were aged 3 to <72 months, resided in study communities, and were insured by a participating commercial health plan or Medicaid. RESULTS. The data include 223135 person-years of observation. Antibiotic-use rates at baseline were 2.8, 1.7, and 1.4 antibiotics per person-year among those aged 3 to <24, 24 to <48, and 48 to <72 months, respectively. We observed a substantial downward trend in antibiotic prescribing, even in the absence of intervention. The intervention had no additional effect among children aged 3 to <24 months but was responsible for a 4.2% decrease among those aged 24 to <48 months and a 6.7% decrease among those aged 48 to <72 months. The intervention effect was greater among Medicaid-insured children and for broad-spectrum agents. CONCLUSIONS. A sustained, multifaceted, community-level intervention was only modestly successful at decreasing overall antibiotic use beyond substantial secular trends. The more robust impact among Medicaid-insured children and for specific medication classes provides an argument for specific targeting of resources for patient and physician behavior change.

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Antibiotic Prescribing for Children With Colds, Upper Respiratory Tract Infections, and Bronchitis

Cited by 591 publications

References 13 publications

Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

Pediatrician and Family Physician Prescription of Selective Serotonin Reuptake Inhibitors

Knowledge and attitudes towards the use of antibiotics in the paediatric age group: a multicenter survey in Italy

Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts

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