Factors predicting antibiotic prescription and referral to hospital for children with respiratory symptoms: secondary analysis of a randomised controlled study at out-of-hours services in primary care

Abstract

ObjectivesAcute respiratory infections and fever among children are highly prevalent in primary care. It is challenging to distinguish between viral and bacterial infections. Norway has a relatively low prescription rate of antibiotics, but it is still regarded as too high as the antimicrobial resistance is increasing. The aim of the study was to identify predictors for prescribing antibiotics or referral to hospital among children.DesignSecondary analysis of a randomised controlled study.Setting4 out-of-hours services and 1 paediatric emergency clinic in Norwegian primary care.Participants401 children aged 0–6 years with respiratory symptoms and/or fever visiting the out-of-hours services.Outcomes2 main outcome variables were registered: antibiotic prescription and referral to hospital.ResultsThe total prescription rate of antibiotics was 23%, phenoxymethylpenicillin was used in 67% of the cases. Findings on ear examination (OR 4.62; 95% CI 2.35 to 9.10), parents' assessment that the child has a bacterial infection (OR 2.45; 95% CI 1.17 to 5.13) and a C reactive protein (CRP) value >20 mg/L (OR 3.57; 95% CI 1.43 to 8.83) were significantly associated with prescription of antibiotics. Vomiting in the past 24 hours was negatively associated with prescription (OR 0.26; 95% CI 0.13 to 0.53). The main predictors significantly associated with referral to hospital were respiratory rate (OR 1.07; 95% CI 1.03 to 1.12), oxygen saturation <95% (OR 3.39; 95% CI 1.02 to 11.23), signs on auscultation (OR 5.57; 95% CI 1.96 to 15.84) and the parents' assessment before the consultation that the child needs hospitalisation (OR 414; 95% CI 26 to 6624).ConclusionsCRP values >20 mg/L, findings on ear examination, use of paracetamol and no vomiting in the past 24 hours were significantly associated with antibiotic prescription. Affected respiration was a predictor for referral to hospital. The parents' assessment was also significantly associated with the outcomes.Trial registration numberNCT02496559; Results.

Appropriateness and Factors Associated with Antibiotics Prescription to Outpatients with Respiratory Tract Infection in Tema Polyclinic, Ghana.

“…More than half (59.7%) of the RTI patients in the present study received at least one antibiotic. This is comparable to the 59.0% antibiotic prescription in a study in NANTES University hospital (43) and 63% from the National Ambulatory Medical Care Survey (44) . Conversely, our estimate is lower than 67.5% and 82.5%, obtained in the study at Ridge Hospital and Adabraka Polyclinic, Accra, Ghana, respectively (18).…”

Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review

“…Perceived severity of the illness and abnormal results on clinical examination predicted increased antibiotic prescription [ 41 , 55 , 128 – 133 ]. Such prescribing may well be appropriate.…”

In-vitro diagnostic point-of-care tests in paediatric ambulatory care: A systematic review and meta-analysis

“…There were 24 RCTs of which 11 were cluster RCTs [31][32][33][34][35][36][37][38][39][40][41], one a quasi-randomised trial (term used by study authors) [42], and the remaining 12 studies were individually randomised RCTs [5,[43][44][45][46][47][48][49][50][51][52][53]. Two RCTs had a 90% overlap in the population [31,32].…”