Childhood Infections, Antibiotics, and Resistance

Abstract

Parental misconceptions and even “demand” for unnecessary antibiotics were previously viewed as contributors to overuse of these agents. We conducted focus groups to explore the knowledge and attitudes surrounding common infections and antibiotic use in the current era of more judicious prescribing. Among diverse groups of parents, we found widespread use of home remedies and considerable concern regarding antibiotic resistance. Parents generally expressed the desire to use antibiotics only when necessary. There was appreciation of inherent error in the diagnosis of common infections, with most trust placed in providers with whom parents had longstanding relationships. While some parents had experience with “watchful waiting” for otitis media, there was little enthusiasm for this approach. While there may still be room for further education, it appears that parents have become more informed and sophisticated regarding appropriate uses of antibiotics. This has likely contributed to the declines seen in their use nationally.

Parents’ Expectations and Experiences of Antibiotics for Acute Respiratory Infections in Primary Care

“…Our findings are largely in line with those of previous studies on parental beliefs about antibiotics' benefits for acute respiratory infections, [18][19][20][21][22][23][24][25][26] although our study is among the first to quantify them. Of course, such expectations were not homogeneous across parents and illnesses-parents knew that not using antibiotics is sometimes acceptable, consistent with previous findings.…”

“…18,25,29 Fewer parents mentioned common antibiotic harms consistent with empirical evidence, such as diarrhea and candidiasis 30 , and some of the complications that parents nominated as being reduced by antibiotic use are not clearly supported by evidence from randomized trials. Parents reported widespread use of alternatives to antibiotics in line with previous findings, 18,23 most of which have no or weak empirical evidence of efficacy, 31,32 with the exceptions being analgesics and antipyretics, and honey for cough. 33 Antibiotic use for acute respiratory infections is usually a decision that is sensitive to patient preference 34 because the benefit-harm trade-off is marginal.…”

A systematic review to explore influences on parental attitudes towards antibiotic prescribing in children

“…A dominant theme, identified in the majority of the studies, was the variation in parental knowledge, attitudes and practices on antibiotic use and misuse in children with upper respiratory tract infections (URTIs) (Agarwal et al., ; Al‐Dossari, ; Alili‐Idrizi et al., ; Alkhaldi et al., ; Brookes‐Howell et al., ; Chan & Tang, ; Chinnasami et al., ; Ecker et al., ; Farha, Suyagh, Alsakran, Alsous, & Alefishat, ; Finkelstein et al., ; Panagakou et al., ; Rousounidis et al., ; Salazar et al., ; Wun et al., ; Yu et al., ; Zyoud et al., ). In fifteen studies, the levels of education were cited as significant to parents' knowledge (Agarwal et al., ; Al‐Dossari, ; Alili‐Idrizi et al., ; Alkhaldi et al., ; Chan & Tang, ; Chinnasami et al., ; Dwibedi et al., ; Ecker et al., ; Farha et al., ; Panagakou et al., ; Rousounidis et al., ; Salazar et al., ; Salonga, ; Vaz et al., ; Yu et al., ).…”

“…Nine studies identified the belief that symptoms caused by viral illnesses required antibiotic treatment (Agarwal et al., ; Alkhaldi et al., ; Chinnasami et al., ; Farha et al., ; Finkelstein et al., ; Rousounidis et al., ; Wun et al., ; Yu et al., ; Zyoud et al., ).…”

A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study

“…It has been reported that there has been a shift from parents' expectation and demand for antibiotics when their child is unwell to concerns regarding antibiotic resistance related to unnecessary prescribing. 75 This may be a result of awareness campaigns about the links between antimicrobial use and antimicrobial resistance. Future research to evaluate parental treatment preferences in terms of the perceived efficacy of antibiotics, adherence to standard eczema care and impact on quality of life may be warranted.…”