Predictors for under-prescribing antibiotics in children with respiratory infections requiring antibiotics

Kornblith, Aaron E.; Fahimi, Jahan; Kanzaria, Hemal K.; Wang, Ralph

doi:10.1016/j.ajem.2017.07.081

Cited by 16 publications

(17 citation statements)

References 32 publications

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“…One paper on febrile children also provide separate numbers for pneumonia and UTI ( 3 ) and one for AOM ( 61 ). Two additional papers focused on respiratory infections and provided separate numbers for pneumonia, AOM and RTI other ( 44 , 56 ).…”

Section: Resultsmentioning

confidence: 99%

“…Three high quality, six moderate quality and two low quality studies reported on SBI rate, which ranged from 7 to 41% (Figure 2 ) ( 3 , 26 , 35 – 38 , 42 , 44 , 50 , 60 , 71 ). As the SBI rate in Khine et al ( 42 ) is similar to antibiotic prescriptions, one may question how SBI is defined.…”

Section: Resultsmentioning

confidence: 99%

“…Five ( 39 , 42 , 47 , 63 , 72 ) out of seven studies [three high quality studies ( 44 , 47 , 66 )], reported significant lower antibiotic prescriptions by pediatric emergency physicians compared to general emergency physicians (Table 3 ). Two addressed young children with fever without source ( 39 , 42 ), and five addressed older children with respiratory tract infections ( 19 , 44 , 47 , 63 , 65 ).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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“…The percentages of antibiotic underuse in our study were low. In literature, underuse up to 31% for children with pneumonia has been described [23,24]. Therefore, we performed a post hoc analysis on a selection of patients for whom information about the timing of antibiotic administration was available.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic misuse in respiratory tract infections in children and adults—a prospective, multicentre study (TAILORED Treatment)

Houten

Golan‐Cohen

Engelhard

et al. 2019

Eur J Clin Microbiol Infect Dis

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Respiratory tract infections (RTI) are more commonly caused by viral pathogens in children than in adults. Surprisingly, little is known about antibiotic use in children as compared to adults with RTI. This prospective study aimed to determine antibiotic misuse in children and adults with RTI, using an expert panel reference standard, in order to prioritise the target age population for antibiotic stewardship interventions. We recruited children and adults who presented at the emergency department or were hospitalised with clinical presentation of RTI in The Netherlands and Israel. A panel of three experienced physicians adjudicated a reference standard diagnosis (i.e. bacterial or viral infection) for all the patients using all available clinical and laboratory information, including a 28-day follow-up assessment. The cohort included 284 children and 232 adults with RTI (median age, 1.3 years and 64.5 years, respectively). The proportion of viral infections was larger in children than in adults (209(74%) versus 89(38%), p < 0.001). In case of viral RTI, antibiotics were prescribed (i.e. overuse) less frequently in children than in adults (77/209 (37%) versus 74/89 (83%), p < 0.001). One (1%) child and three (2%) adults with bacterial infection were not treated with antibiotics (i.e. underuse); all were mild cases. This international, prospective study confirms major antibiotic overuse in patients with RTI. Viral infection is more common in children, but antibiotic overuse is more frequent in adults with viral RTI. Together, these findings support the need for effective interventions to decrease antibiotic overuse in RTI patients of all ages. Electronic supplementary material The online version of this article (10.1007/s10096-018-03454-2) contains supplementary material, which is available to authorized users.

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“…Although race has been associated with antibiotic prescribing, race was well balanced before and after propensity score matching and not included in the model. 31 Previous studies have reported that antibiotic prescribing is not statistically impacted by the radiologist's impression from the CXR. 21,32 Therefore, ED CXR results were not included in determining the propensity score.…”

Section: Figurementioning

confidence: 93%

Antibiotic Use and Outcomes in Children in the Emergency Department With Suspected Pneumonia

Lipshaw¹,

Eckerle

Florin

et al. 2020

Pediatrics

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BACKGROUND AND OBJECTIVES: Antibiotic therapy is often prescribed for suspected communityacquired pneumonia (CAP) in children despite a lack of knowledge of causative pathogen. Our objective in this study was to investigate the association between antibiotic prescription and treatment failure in children with suspected CAP who are discharged from the hospital emergency department (ED). METHODS: We performed a prospective cohort study of children (ages 3 months-18 years) who were discharged from the ED with suspected CAP. The primary exposure was antibiotic receipt or prescription. The primary outcome was treatment failure (ie, hospitalization after being discharged from the ED, return visit with antibiotic initiation or change, or antibiotic change within 7-15 days from the ED visit). The secondary outcomes included parentreported quality-of-life measures. Propensity score matching was used to limit potential bias attributable to treatment selection between children who did and did not receive an antibiotic prescription. RESULTS: Of 337 eligible children, 294 were matched on the basis of propensity score. There was no statistical difference in treatment failure between children who received antibiotics and those who did not (odds ratio 1.0; 95% confidence interval 0.45-2.2). There was no difference in the proportion of children with return visits with hospitalization (3.4% with antibiotics versus 3.4% without), initiation and/or change of antibiotics (4.8% vs 6.1%), or parentreported quality-of-life measures. CONCLUSIONS: Among children with suspected CAP, the outcomes were not statistically different between those who did and did not receive an antibiotic prescription.

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Predictors for under-prescribing antibiotics in children with respiratory infections requiring antibiotics

Cited by 16 publications

References 32 publications

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

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

Antibiotic misuse in respiratory tract infections in children and adults—a prospective, multicentre study (TAILORED Treatment)

Antibiotic Use and Outcomes in Children in the Emergency Department With Suspected Pneumonia

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