Antibiotic use in ambulatory care for acutely ill children in high-income countries: a systematic review and meta-analysis

Abstract

ObjectiveTo determine the rate and appropriateness of antibiotic prescribing for acutely ill children in ambulatory care in high-income countries.DesignOn 10 February 2021, we systematically searched articles published since 2000 in MEDLINE, Embase, CENTRAL, Web Of Science and grey literature databases. We included cross-sectional and longitudinal studies, time-series analyses, randomised controlled trials and non-randomised studies of interventions with acutely ill children up to and including 12 years of age in ambulatory care settings in high-income countries. Pooled antibiotic prescribing and appropriateness rates were calculated using random-effects models. Meta-regression was performed to describe the relationship between the antibiotic prescribing rate and study-level covariates.ResultsWe included 86 studies comprising 11 114 863 children. We found a pooled antibiotic prescribing rate of 45.4% (95% CI 38.2% to 52.8%) for all acutely ill children, and 85.6% (95% CI 73.3% to 92.9%) for acute otitis media, 37.4% (95% CI 30.9% to 44.3%) for respiratory tract infections, and 40.4% (95% CI 29.9% to 51.9%) for other diagnoses. Considerable heterogeneity can only partly be explained by differences in diagnoses. The overall pooled appropriateness rate is 68.5% (95% CI 55.8% to 78.9%, I²=99.8%; 19 studies, 119 995 participants). 38.3% of all prescribed antibiotics were aminopenicillins.ConclusionsAntibiotic prescribing rates for acutely ill children in ambulatory care in high-income countries remain high. Large differences in prescription rates between studies can only partly be explained by differences in diagnoses. Better registration and further research are needed to investigate patient-level data on diagnosis and appropriateness.

The impact of probiotics and vitamin C on the prevention of upper respiratory tract symptoms in two preschool children cohorts

“…The overprescribing of antibiotics for acute respiratory tract infections in the paediatric population is still common, raising the public health concern of antibiotic resistance [ 40 ]. A meta-analysis on the prevention of acute URTIs has shown that infants and children supplemented with probiotics had a 41% lower risk of being prescribed antibiotics compared to placebo [ 14 ].…”

The role of antibiotic exposure and the effects of breastmilk and human milk feeding on the developing infant gut microbiome

“…In the infant and pediatric populations from high income setting, antibiotic prescription rates in acute care exceed 35%, many in the first 30 days of life ( 9 ), whereas antibiotic prescription rates exceed 45% in outpatient care ( 12 ). As such, close to half of all children will be exposed to antibiotics during critical windows of development.…”

Incidence of acute otitis media from 2003 to 2019 in children ≤ 17 years in England

“…In the UK, antibiotic prescribing rates in children with AOM are high. A recent systematic review analyzing the use of antibiotics in ambulatory care for acutely ill children in high-income countries, including the UK, reported the antibiotic prescribing rate for AOM was 85.6% (95% confidence interval, CI 73.3–92.9%) [ 12 ]. As a result, the National Institute for Health and Care Excellence (NICE) guideline for AOM antimicrobial prescribing was updated in March 2022 to aim to limit antibiotic use and reduce antimicrobial resistance [ 13 ].…”