Antibiotics for preventing suppurative complications from undifferentiated acute respiratory infections in children under five years of age

Galvão, Márcia G Alves; Santos, Marilene Augusta Rocha Crispino; Cunha, Antonio JL Alves da

doi:10.1002/14651858.cd007880.pub2

Cited by 11 publications

(9 citation statements)

References 64 publications

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“…Even if the lower confidence intervals for the estimate are taken, more than 200 children would need to be given an immediate antibiotic for one hospitalisation to be prevented. These findings are in agreement with evidence from systematic reviews 11 – 13 , 32 where little or no evidence was found to support their use in children or adults. The authors found similar estimates for reconsultations for deterioration with that of one large cohort study investigating new or non-resolving symptoms in adult sore throat.…”

Section: Discussionsupporting

confidence: 88%

Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study

Redmond

Turnbull²,

Stuart

et al. 2018

Br J Gen Pract

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BackgroundClinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presenting in primary care with cough and respiratory symptoms, despite limited meaningful evidence of impact on these outcomes.AimTo estimate the effect of children’s antibiotic prescribing on adverse outcomes within 30 days of initial consultation.Design and settingSecondary analysis of 8320 children in a multicentre prospective cohort study, aged 3 months to <16 years, presenting in primary care across England with acute cough and other respiratory symptoms.MethodBaseline clinical characteristics and antibiotic prescribing data were collected, and generalised linear models were used to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations and reconsultation for deterioration), controlling for clustering and clinicians’ propensity to prescribe antibiotics.ResultsSixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted for deterioration. Clinicians prescribed immediate and delayed antibiotics to 2313 (28%) and 771 (9%), respectively. Compared with no antibiotics, there was no clear evidence that antibiotics reduced hospitalisations (immediate antibiotic risk ratio [RR] 0.83, 95% confidence interval [CI] = 0.47 to 1.45; delayed RR 0.70, 95% CI = 0.26 to 1.90, overall P = 0.44). There was evidence that delayed (rather than immediate) antibiotics reduced reconsultations for deterioration (immediate RR 0.82, 95% CI = 0.65 to 1.07; delayed RR 0.55, 95% CI = 0.34 to 0.88, overall P = 0.024).ConclusionMost children presenting with acute cough and respiratory symptoms in primary care are not at risk of hospitalisation, and antibiotics may not reduce the risk. If an antibiotic is considered, a delayed antibiotic prescription may be preferable as it is likely to reduce reconsultation for deterioration.

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Section: Discussionsupporting

confidence: 88%

Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study

Redmond

Turnbull²,

Stuart

et al. 2018

Br J Gen Pract

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“…We chose childhood URTIs because they are common and mostly viral. Use of antibiotics does not shorten the duration or prevent complications, unless the infection is bacterial and/or symptoms are severe . Thus, the antibiotic prescribing rate for outpatient childhood UTRIs provides a ‘proxy’ to measure the appropriateness of prescribing behaviour use in health facilities .…”

Section: Methodsmentioning

confidence: 99%

Impact of China's essential medicines scheme and zero‐mark‐up policy on antibiotic prescriptions in county hospitals: a mixed methods study

Wei

Yin

Walley

et al. 2017

Tropical Med Int Health

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“…Examining prescriptions for childhood upper respiratory infections (URI) is a commonly accepted strategy to evaluate rationality of antibiotic use, as most URI are viral where antibiotics do not shorten the duration of the URI or prevent complications [ 10 ]. However, antibiotic prescribing for childhood URI is still often seen in practice, ranging from 20–90% [ 11 ], the highest rates being reported in Africa and Asia [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions

Zhang¹,

Zou

et al. 2017

Global Health Action

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Background: Overuse of antibiotics contributes to the development of antimicrobial resistance.Objective: This study aims to assess the condition of antibiotic use at health facilities at county, township and village levels in rural Guangxi, China.Methods: We conducted a cross-sectional study of outpatient antibiotic prescriptions in 2014 for children aged 2–14 years with upper respiratory infections (URI). Twenty health facilities were randomly selected, including four county hospitals, eight township hospitals and eight village clinics. Prescriptions were extracted from the electronic records in the county hospitals and paper copies in the township hospitals and village clinics.Results: The antibiotic prescription rate was higher in township hospitals (593/877, 68%) compared to county hospitals (2736/8166, 34%) and village clinics (96/297, 32%) (p < 0.001). Among prescriptions containing antibiotics, county hospitals were found to have the highest use rate of broad-spectrum antibiotics (82 vs 57% [township], vs 54% [village], p < 0.001), injectable antibiotics (65 vs 43% [township], vs 33% [village], p < 0.001) and multiple antibiotics (47 vs 15% [township], vs 0% [village], p < 0.001). Logistic regression showed that the likelihood of prescribing an antibiotic was significantly associated with patients being 6–14 years old compared with being 2–5 years old (adjusted odds ratio [aOR] = 1.3, 95% CI 1.2–1.5), and receiving care at township hospitals compared with county hospitals (aOR = 5.0, 95% CI 4.1–6.0). Prescriptions with insurance copayment appeared to lower the risk of prescribing antibiotics compared with those without (aOR = 0.8, 95% CI 0.7–0.9).Conclusions: Inappropriate use of antibiotics was high for outpatient childhood URI in the four counties of Guangxi, China, with the highest rate found in township hospitals. A significant high proportion of prescriptions containing antibiotics were broad-spectrum, by intravenous infusion or with multiple antibiotics, especially at county hospitals. Urgent attention is needed to address this challenge.

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Antibiotics for preventing suppurative complications from undifferentiated acute respiratory infections in children under five years of age

Cited by 11 publications

References 64 publications

Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study

Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study

Impact of China's essential medicines scheme and zero‐mark‐up policy on antibiotic prescriptions in county hospitals: a mixed methods study

Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions

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