Antibiotic Use in Febrile Children Presenting to the Emergency Department: A Systematic Review

Abstract

Introduction: While fever is the main complaint among pediatric emergency services and high antibiotic prescription are observed, only a few studies have been published addressing this subject. Therefore this systematic review aims to summarize antibiotic prescriptions in febrile children at the ED and assess its determinants.Methods: We extracted studies published from 2000 to 2017 on antibiotic use in febrile children at the ED from different databases. Author, year, and country of publishing, study design, inclusion criteria, primary outcome, age, and number of children included in the study was extracted. To compare the risk-of-bias all articles were assessed using the MINORS criteria. For the final quality assessment we additionally used the sample size and the primary outcome.Results: We included 26 studies reporting on antibiotic prescription and 28 intervention studies on the effect on antibiotic prescription. In all 54 studies antibiotic prescriptions in the ED varied from 15 to 90.5%, pending on study populations and diagnosis. Respiratory tract infections were mostly studied. Pediatric emergency physicians prescribed significantly less antibiotics then general emergency physicians. Most frequent reported interventions to reduce antibiotics are delayed antibiotic prescription in acute otitis media, viral testing and guidelines.Conclusion: Evidence on antibiotic prescriptions in children with fever presenting to the ED remains inconclusive. Delayed antibiotic prescription in acute otitis media and guidelines for fever and respiratory infections can effectively reduce antibiotic prescription in the ED. The large heterogeneity of type of studies and included populations limits strict conclusions, such a gap in knowledge on the determining factors that influence antibiotic prescription in febrile children presenting to the ED remains.

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

“…This is as expected, since the previously reported rates were calculated in relation to the number of inhabitants, whereas our review only considered acutely ill children. This review confirms that heterogeneity is intrinsic to this type of research 9–12. Compared with similar reviews,9–12 this review represents a greater number of countries and healthcare settings.…”

“…This review confirms that heterogeneity is intrinsic to this type of research. 9-12 Compared with similar reviews, [9][10][11][12] this review represents a greater number of countries and healthcare settings. Further, we used a more elaborate search strategy.…”

“…Records on antibiotic use for various infections are still fragmented and difficult to retrieve 8. Previous reviews on prescribing rates for children are outdated and survey based,9 examine drug prescriptions in general,10 11 are either performed in an inpatient or very specific setting,11 12 or do not address acutely ill children specifically 9 10. In this systematic review, we aim to collate all available evidence on the proportion of acutely ill children being prescribed antibiotics in ambulatory care in high-income countries and evaluate the appropriateness of these prescriptions.…”

Variation in antibiotic prescription rates in febrile children presenting to emergency departments across Europe (MOFICHE): A multicentre observational study

“…A literature review on antibiotic prescription rates and their determinants in febrile children in emergency care found large heterogeneity of studied populations, which limited the ability to draw conclusions [16]. One recent European study, focusing solely on EDs, showed significant differences in antibiotic prescription rates in otherwise healthy children with respiratory tract infections (RTIs) [5].…”

Improving the Quality of Hospital Antibiotic Use: Impact on Multidrug-Resistant Bacterial Infections in Children

“…Unfortunately, in both hospital and outpatient settings, the prescription of broad-spectrum antibiotics is often inappropriate or unnecessary (e.g., patients with viral infections or noninfectious diseases) in 50% of cases (Hecker et al, 2003). This practice is closely related to the increase in AMR ( van de Voort et al, 2018) and other issues, including the increased incidence of Clostridium difficile infections (Baur et al, 2017). In 2019, Josephine et al carried out a detailed analysis on the variability of prescriptions in certain hospitals (considering a population of children without comorbidities who had received antibiotics) by country, focus of the infection (particularly with respect to the respiratory tract) and type of antibiotic; they noted that differences in patient combination, diagnostic evaluation or hospital characteristics could not justify all the variability of antibiotic prescription, thus suggesting overuse ( van de Maat et al, 2019).…”