Interventions to Influence Consulting and Antibiotic Use for Acute Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

Abstract

BackgroundRespiratory tract infections (RTIs) are common in children and generally self-limiting, yet often result in consultations to primary care. Frequent consultations divert resources from care for potentially more serious conditions and increase the opportunity for antibiotic overuse. Overuse of antibiotics is associated with adverse effects and antimicrobial resistance, and has been shown to influence how patients seek care in ensuing illness episodes.Methodology/Principal FindingsWe conducted a systematic review and meta-analysis to assess the effectiveness of interventions directed towards parents or caregivers which were designed to influence consulting and antibiotic use for respiratory tract infections (RTIs) in children in primary care. Main outcomes were parental consulting rate, parental knowledge, and proportion of children subsequently consuming antibiotics. Of 5,714 references, 23 studies (representing 20 interventions) met inclusion criteria. Materials designed to engage children in addition to parents were effective in modifying parental knowledge and behaviour, resulting in reductions in consulting rates ranging from 13 to 40%. Providing parents with delayed prescriptions significantly decreased reported antibiotic use (Risk Ratio (RR) 0.46 (0.40, 0.54); moreover, a delayed or no prescribing approach did not diminish parental satisfaction.ConclusionsIn order to be most effective, interventions to influence parental consulting and antibiotic use should: engage children, occur prior to an illness episode, employ delayed prescribing, and provide guidance on specific symptoms. These results support the wider implementation of interventions to reduce inappropriate antibiotic use in children.

Reducing antibiotic prescribing for children with respiratory tract infections in primary care: a systematic review

“…Two reviewers used an extraction form developed for a previous systematic review 10 to independently extract data for study design, setting, patient population, intervention, comparison, outcome(s), and assessment method. Disagreements were resolved by discussion with a third author.…”

“…10 However, strategies are also needed to help clinicians determine which children are most in need of antibiotics, 11 and reduce inappropriate antibiotic prescribing. 12,13 Given the importance of the parent-clinician interaction in guiding antibiotic use, this study aimed to systematically review the effectiveness of educational or behavioural interventions directed to parents, clinicians, or both, to reduce antibiotic prescribing for children with RTIs in primary care.…”

Mothers’ approach on the use of antibiotics in children: how effective is short information?

“…Yapılan çalışmalar, eğitimin antibiyotik kullanımı üzerindeki olumlu etkisini kanıtlamıştır ancak süreklilik arz etmelidir. [7][8][9][10][11][12] Halka yönelik eğitim programlarının oluşturulmasında bu konudaki yanlış inanışların, bilgilerin saptanması ve doktor üzerinde antibiyotik reçetelenmesi için baskı oluşturma, önerilen antibiyotiği uygun dozaj ve sürede kullanma ve doktor tavsiyesi olmadan antibiyotik kullanma konularındaki tutumların irdelenmesi gereklidir.…”

E-health and consultation rates for respiratory illnesses in infants: a randomised clinical trial in primary care

“…20,24,25 A recent review demonstrated that, in order to be most effective, interventions to influence parental consulting and antibiotic use should engage children, occur prior to an illness episode, and provide guidance on specific symptoms. 36 While this intervention meets these recommendations, one of the reasons that this program did not influence healthcare behaviour could be that there is already so much information on the internet. Although it was developed with the input of parents, and most parents judged it as clear and complete, the content may not fully connect to the desired information.…”