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Prospective study of antibiotic prescribing for children.

Abstract

OBJECTIVES

To observe the frequency with which children in outpatient primary care settings are prescribed antibiotics and to investigate why these antibiotics are prescribed. To compare the prescribing behaviour of family doctors, primary care pediatricians, and urgent care physicians and to determine where refinements in management are most needed to reduce the number of antibiotic prescriptions appropriately.

DESIGN

Prospective study using a data entry form with mostly closed-ended questions.

SETTING

Ten primary care offices in urban south-central and eastern Ontario: five family practices, three pediatric practices, and two urgent care centres (UCC).

PARTICIPANTS

Every child younger than 16 years visiting these offices during a 3-week period in February and March 1997.

MAIN OUTCOME MEASURES

Frequency, clinical indications, and nature of the antibiotics prescribed.

RESULTS

There were 4344 observed visits. Of 1706 antibiotic prescriptions, 1481 were for 10 days, and 1577 (92%) were for acute respiratory infections, 920 (53%) specifically for acute otitis media (AOM). Full courses of antibiotics were given immediately (i.e., without test results) to 321 (76%) of 425 children with pharyngitis. Antibiotics were prescribed for 145 (90%) of 163 children with bronchitis. Urgent care physicians were significantly more likely than pediatricians or family physicians to prescribe immediate antibiotics and to disregard guidelines when choosing antibiotics for uncomplicated AOM.

CONCLUSIONS

Three diagnoses accounted for 82% of antibiotic prescriptions: AOM, pharyngitis, and bronchitis. Physicians should be more selective when deciding whether, and for how long, to prescribe antibiotics for those three common conditions. Substantial reductions in antibiotic use will require changes in how physicians manage suspected AOM, the most common indication for antibiotics.

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  • Authors+Show Affiliations

    Department of Pathology, McMaster University Faculty of Health Sciences, Hamilton, Ont. rpennie@mcmaster.ca

    Source

    MeSH

    Acute Disease
    Adolescent
    Anti-Bacterial Agents
    Child
    Child, Preschool
    Drug Prescriptions
    Drug Utilization
    Emergency Medicine
    Family Practice
    Guideline Adherence
    Health Services Research
    Humans
    Infant
    Infant, Newborn
    Ontario
    Otitis Media
    Pediatrics
    Practice Guidelines as Topic
    Practice Patterns, Physicians'
    Prospective Studies
    Respiratory Tract Infections
    Surveys and Questionnaires

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    9789665

    Citation

    Pennie, R A.. "Prospective Study of Antibiotic Prescribing for Children." Canadian Family Physician Medecin De Famille Canadien, vol. 44, 1998, pp. 1850-6.
    Pennie RA. Prospective study of antibiotic prescribing for children. Can Fam Physician. 1998;44:1850-6.
    Pennie, R. A. (1998). Prospective study of antibiotic prescribing for children. Canadian Family Physician Medecin De Famille Canadien, 44, pp. 1850-6.
    Pennie RA. Prospective Study of Antibiotic Prescribing for Children. Can Fam Physician. 1998;44:1850-6. PubMed PMID: 9789665.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prospective study of antibiotic prescribing for children. A1 - Pennie,R A, PY - 1998/10/28/pubmed PY - 1998/10/28/medline PY - 1998/10/28/entrez SP - 1850 EP - 6 JF - Canadian family physician Medecin de famille canadien JO - Can Fam Physician VL - 44 N2 - OBJECTIVES: To observe the frequency with which children in outpatient primary care settings are prescribed antibiotics and to investigate why these antibiotics are prescribed. To compare the prescribing behaviour of family doctors, primary care pediatricians, and urgent care physicians and to determine where refinements in management are most needed to reduce the number of antibiotic prescriptions appropriately. DESIGN: Prospective study using a data entry form with mostly closed-ended questions. SETTING: Ten primary care offices in urban south-central and eastern Ontario: five family practices, three pediatric practices, and two urgent care centres (UCC). PARTICIPANTS: Every child younger than 16 years visiting these offices during a 3-week period in February and March 1997. MAIN OUTCOME MEASURES: Frequency, clinical indications, and nature of the antibiotics prescribed. RESULTS: There were 4344 observed visits. Of 1706 antibiotic prescriptions, 1481 were for 10 days, and 1577 (92%) were for acute respiratory infections, 920 (53%) specifically for acute otitis media (AOM). Full courses of antibiotics were given immediately (i.e., without test results) to 321 (76%) of 425 children with pharyngitis. Antibiotics were prescribed for 145 (90%) of 163 children with bronchitis. Urgent care physicians were significantly more likely than pediatricians or family physicians to prescribe immediate antibiotics and to disregard guidelines when choosing antibiotics for uncomplicated AOM. CONCLUSIONS: Three diagnoses accounted for 82% of antibiotic prescriptions: AOM, pharyngitis, and bronchitis. Physicians should be more selective when deciding whether, and for how long, to prescribe antibiotics for those three common conditions. Substantial reductions in antibiotic use will require changes in how physicians manage suspected AOM, the most common indication for antibiotics. SN - 0008-350X UR - https://www.unboundmedicine.com/medline/citation/9789665/Prospective_study_of_antibiotic_prescribing_for_children_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/9789665/ DB - PRIME DP - Unbound Medicine ER -