Parents’ Perspective of Antibiotic Usage in Children: A Nationwide Survey in Italy

Abstract

on behalf of the Surveys in Pediatric Infectious Diseases study group∥∥∥∥Background: Antibiotics represent the most widely prescribed drugs in children worldwide, both in hospital and community settings. A comprehensive approach to understanding the reasons and determinants of antibiotic prescription in the pediatric age is needed. This study aimed to assess parents' attitudes and perspectives about antibiotic use. Methods: Prospective observational study was conducted in all ItalianRegions between February 1 and April 30, 2020, using a standardized questionnaire. Results: Six thousand six hundred twenty-five parents from all Italian regions completed the survey. Seventy-six percent of parents were aware that only bacteria are the target of antibiotics, but 92.9% knew that the antibiotic has no direct effect on fever. Antibiotic self-prescription (10.4%) or by remote consultation by phone call (19.9%) or message (9.6%) were relatively common. Ninety-three percent of parents were aware that excessive use of antibiotics could select resistant bacteria and 84.7% of them knew that they could actively fight antibiotic resistance. About two thirds of participants (66.1%) received information on antibiotic resistance from their family pediatrician. Parents born of Italy or those with lower income had a higher probability of having less information from pediatricians or knowledge of proper antibiotic use. Discussion: Our study suggests that parents' knowledge and attitudes toward antibiotic use and prescription are improving compared with previous studies, while there is still a gap regarding antibiotic resistance, particularly on practices that can reduce its burden. Our study's negative finding is that families from low-income settings or those born abroad have significantly more misconceptions about important antibiotic practices.

Evaluation of parental knowledge, attitudes and practices regarding antibiotic use in acute upper respiratory tract infections in children under 18 years of age: a cross-sectional study in Turkey

“…While the rate of agreeing with this statement was 72.4% in a study conducted in Jordan [ 14 ], it was found to be lower than 10% in the study conducted in Greece [ 24 ]. In a study conducted in Italy, 92.9% of respondents knew that antibiotics did not have a direct effect on fever [ 25 ]. Parents agreed with 37% that antibiotics could be used in the treatment of infections caused by viruses.…”

Determinants of antibiotic prescriptions in a large cohort of children discharged from a pediatric emergency department

“…These data are in line with previous studies from Europe and the USA [5,7,[11][12][13], and despite that our cohort is more recent, the evidence of overprescription of antibiotics in pediatric ED is still a major and unsolved problem. A recent large survey of Italian parents confirmed that Am/Cl was the most used antibiotic [3]. Despite that the majority of guidelines suggest amoxicillin as a first-line treatment for pharyngitis [14], pneumonia [15], and otitis media [16], Am/Cl was the most prescribed in all age groups and discharge diagnostic categories.…”

“…Finally, psychological factors may be an important, and more difficult to measure, element that can affect final decisions. For example, parental fears and pressures to receive antibiotics and their socioeconomic status may unconsciously impact physicians' decisions [3]. However, to our knowledge, the psychological dynamics of this interplay has never been assessed through prospective studies.…”

“…• The prescription of Am/Cl at discharge (since current literature agrees with this being the most used antibiotic in the pediatric population, despite its wider spectrum and guidelines favor amoxicillin alone for most conditions) [3]. • The prescription of amoxicillin alone at discharge.…”

“…In this context, children are a well-known and recognized target of antibiotic prescriptions [3], making them the category that most uses antibiotics [4]. In particular, primary care and emergency departments (EDs) are settings where overprescription seems particularly high.…”