Antibiotic Prescription in Febrile Children: A Cohort Study during Out-of-Hours Primary Care

Abstract

Background: Fever is common in children and often self-limiting, nevertheless antibiotics are frequently prescribed. We determined how often antibiotics were prescribed in children presenting with fever at a family physicians' out-of-hours service and established the children's signs and symptoms related to antibiotic prescriptions.Patients: Children aged 3 months to 6 years with fever as the main reason for contact. Results: Of the 443 included children, 322 children had a face-to-face contact at the out-of-hours service. Of these, 117 (36.3%) were prescribed antibiotics, that is, 26.5% of the total study population.

Parents’ knowledge, attitudes, and practice in childhood fever: an internet-based survey

“…These expectations could be an important target for interventions aimed at reducing antibiotic prescriptions, especially in an out-of-hours centre as it is known that prescribing figures in out-of-hours care are higher than during routine GP care, with one in three children visiting a GP out-of-hours centre receiving an antibiotic prescription. 22 Although illness severity could be higher in that specific population, it is unlikely that such a high proportion of these infections are likely to benefit from treatment with antibiotics. So are prescriptions a result of patients' expectations or GPs' assumptions about those expectations?…”

Clinical predictors of antibiotic prescribing for acutely ill children in primary care: an observational study

“…12,16,24 There is wide variation in antibiotic prescribing between countries, general practices, and individual doctors. 8,11,12,20,25 Patient factors, such as deprivation and comorbidities; clinician factors, such as previous experience, training, and attitudes towards antibiotics; the doctorpatient relationship and perceived patient expectation; and other factors such as time and workload pressures, have been identified as influencing prescribing.…”

“…17,18,21 Some studies have considered antibiotic prescribing more generally in children but there are few studies based in UK general practice. 16,20 The UK National Institute for Health and Care Excellence (NICE) guidelines recommend 'no' or 'delayed' antibiotic prescribing for most RTIs. 22 Antibiotics are not beneficial for most upper respiratory tract infections (URTIs) including tonsillitis, otitis, acute cough, and colds, with little impact on illness course or complication incidence.…”

“…[10][11][12] Both the decision to prescribe and choice of antibiotic are complex, and influenced by both clinical and non-clinical factors. [13][14][15][16][17][18][19][20] Most studies have focused on prescribing for respiratory tract infections (RTIs). 17,18,21 Some studies have considered antibiotic prescribing more generally in children but there are few studies based in UK general practice.…”

Predicting prolonged duration of fever in children: a cohort study in primary care

“…2,21 Some signs may have altered over the short period between initial consultation and the home visit by the research nurse (such as, YOS, ill appearance, dyspnoea, capillary refill, chin on chest, and rectal temperature ≥38.0°C). However, the research nurse specifically asked for the symptoms that were present at the time of consultation with the out-ofhours service.…”