Factors Associated with Prescribing Broad-Spectrum Antibiotics for Children with Upper Respiratory Tract Infections in Ambulatory Care Settings

Abstract

Objectives:Broad-spectrum antibiotics are frequently prescribed for children with upper respiratory tract infections (URI). Excessive use of broad-spectrum antibiotics leads to the emergence of resistant bacteria. This study aimed to identify factors associated with prescribing broad-spectrum antibiotics among children younger than 18 years presenting with URI in outpatient settings.Methods:We conducted a cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey-Outpatient Departments (NHAMCS-OPD) between 2006 and 2010. Descriptive statistics of visits from children with URI were estimated. Simple and multiple logistic regression analyses were used to identify socio-demographic and clinical characteristics associated with broad-spectrum antibiotic prescribing. We also completed a stratified analysis by age (⩽2 vs >2).Results:A total of 4013 outpatient visits for children with URI from both NAMCS and NHAMCS-0PD data were examined. Broad-spectrum antibiotics were prescribed in 39% of the visits, accounting for an estimated 6.8 million visits annually. Multivariable analysis showed that visits in the South region (odds ratio [OR] = 2.38; 95% confidence interval [CI]: 1.38-4.10) compared with the West region and visits with diagnoses of acute sinusitis (OR = 2.77; 95% CI: 1.65-4.63) and acute otitis media (OR = 1.90; 95% CI: 1.32-2.74) compared with those with acute pharyngitis were associated with greater odds of broad-spectrum antibiotic prescribing.Conclusions:The prescribing of broad-spectrum antibiotics is common for children with URI in ambulatory care settings. Diagnosis and management of URI remain a critical area for awareness campaigns promoting judicious use of antibiotics.

Use of antibacterials in the management of symptoms of acute respiratory tract infections among children under five years in Gulu, northern Uganda: Prevalence and determinants

“…The high antibacterial resistance selection pressure created by high antibacterial use is a potential driver of resistance emergence and spread (20), further diminishing the already limited choices of antibacterial therapy for infectious diseases especially in LMICs (10). The high prevalence of antibacterial use reported in this study is similar to reports of previous studies done in LMICs [3,[7][8][9][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. A household survey in Kampala, Uganda, reported lower prevalence (43%) of antibacterial use in treating children under five years compared to the current study [7].…”

“…In this study, amoxicillin, co-trimoxazole and metronidazole were the most commonly used antibacterials, a finding similar to that of previous studies in LMICs [7,9,[29][30][31]. A survey in Namibia [34] found cotrimoxazole, amoxicillin and azithromycin as the most used antibacterials.…”

Development of Antimicrobial Stewardship Programmes in Low and Middle-Income Countries: A Mixed-Methods Study in Nigerian Hospitals

“…Typical features of prescribing in LMICs include high volumes of antibiotic prescribing [16], although these higher levels can be partially linked to greater burden of infectious diseases [17]. Prescribing in LMICs has also been characterized by high empirical use of broad-spectrum antibiotics [8,18,19], non-availability of and/or poor compliance with treatment guidelines [20] and limited use of diagnostic tests [21].…”

Predicting poor outcomes in children aged 1–12 with respiratory tract infections: A systematic review

“…Six studies analysed the association between symptoms, signs, and investigation and antibiotic prescription at the initial consultation. There were five studies analysing associations with antibiotic prescription at the initial contact in 12868 children consulting with a suspected respiratory tract infection [31,32,36,39,44] and one study of 256 children presenting with otitis media in routine clinical practice [45]. Significant associations are reported in Table 4.…”

“…Setting: Primary care [36,44], ED [39], ambulatory care [32], mixed settings [31] WBC greater or less than the reference for age [39] Shortness of breath [39] Fever Wheezing [39] Associated with a raised relative risk of antibiotics in one study based in paediatric primary care offices [36] but not in two others (one set in ambulatory care [32], another with a mix of settings including primary care and ED [31].…”