Outcomes After Judicious Antibiotic Use for Respiratory Tract Infections Seen in a Private Pediatric Practice

Pichichero, Michael E.; Green, John L.; Francis, Anne B.; Marsocci, Steven M.; Murphy, Marie Lynd

doi:10.1542/peds.105.4.753

Cited by 41 publications

(22 citation statements)

References 28 publications

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“…Although parent expectations and physician-parent communication are likely to be influenced by visits during the prior 2 weeks that resulted in an antibiotic prescription, previous research indicates that most episodes of presumed bacterial illness in pediatric patients (66%-86%) result in only 1 physician visit per episode. 39,40 Thus, we do not believe that excluding these parents substantially affected our conclusions.…”

Section: Limitationsmentioning

confidence: 88%

“…We do not know how often this will result in a second visit or what the economic implications would be, that is, the parent's additional loss of time from work or the cost of a second visit. However, in a recent study by Pichichero et al, 39 the investigators reported that 29% (86 of 293) of children with respiratory illnesses who were not prescribed antibiotics during an initial visit ended up having a second unplanned visit. In contrast, children who received antibiotics at the first visit returned unex- Contingency plans enhance satisfaction of parents who want antibiotics but do not receive them.…”

Section: Satisfactionmentioning

confidence: 96%

See 1 more Smart Citation

Parent Expectations for Antibiotics, Physician-Parent Communication, and Satisfaction

Mangione-Smith¹,

McGlynn

Elliott

et al. 2001

Arch Pediatr Adolesc Med

197

137

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Section: Limitationsmentioning

confidence: 88%

Section: Satisfactionmentioning

confidence: 96%

Parent Expectations for Antibiotics, Physician-Parent Communication, and Satisfaction

Mangione-Smith¹,

McGlynn

Elliott

et al. 2001

Arch Pediatr Adolesc Med

197

137

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“…Studies have been carried out to investigate the drug use in acute gastroenteritis [7], acute respiratory infections, etc. [8] The most common presenting complaint in the general practice is fever. So, the present study was carried out to investigate the drug use and the appropriateness of the treatment in cases of acute fever among the GPs in Pune city.…”

Section: Discussionmentioning

confidence: 99%

The Pattern of Drug Use in Acute Fever by General Practitioners (GPs) in Pune City, India

Beri

Pandit²,

Khade³

et al. 2013

JCDR

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Objectives: 1) To determine the WHO Prescribing Core Drug Use (PCDU) indicators in the management of acute fever (of less than 2 weeks duration) of the MBBS (allopathic) and BAMS (ayurvedic) General Practitioners (GPs) in Pune city. 2) To verify the appropriateness of the treatment. and 3) To compare the above parameters of the MBBS and the BAMS practitioners. Methods:Pune city was divided in five zones, north, south, east, west and central. A list of doctors was obtained from the Indian Medical Association and it was divided zone wise. 2 MBBS and 2 BAMS GPs. were selected per zone. An informed consent was obtained from the GPs. The sample size was 20 encounters per GP. The patients of all ages and both sexes, who suffered from fever of less than 2 weeks duration, were included in the study. The indicators which were studied were 1) the WHO Prescribing Core Drug Use indicators and 2) the complimentary drug use indicators for the appropriateness of the treatment. Results:1) The age, sex and diagnosis wise distribution of the patients was comparable in both the groups. 2) Among the WHO PCDU indicators, a highly significant difference was observed in the average number of drugs which was prescribed, the antibiotic usage and in the injections which were prescribed among the MBBS and the BAMS GPs 3) The use of the drugs from EDL and that of the generic drugs were comparable in both the groups.4) A marked irrationality was found in the injectable antimicrobials by the BAMS GPs.5) The selection of the antimicrobials was inappropriate in 64.14% and 17.5% of the encounters which were made by the BAMS and the MBBS GPs respectively. Conclusion:Among the BAMS GPs: the WHO prescribing core drug use indicators were all significantly abnormal and the percentage of the inappropriate prescriptions was alarmingly high (92%). Among the MBBS GPs:There was more use of the antimicrobials but the proportion of the inappropriate prescriptions was less (42%).

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“…[9][10][11][12] Children with VRTIs who do not receive prescriptions for antibiotics do not have higher rates of bacterial infection or return visits to physicians. 36 Children who receive first-line antibiotics for infections such as otitis media or pharyngitis are not more likely than those receiving second-line agents to have delayed resolution of symptoms. 12,37 Despite this abundance of evidence, in our population-based study of 20 000 children in the late 1990s we found that almost half of physician visits for VRTIs resulted in an antibiotic prescription, and second-line antibiotics were prescribed in 20% of visits for common childhood infections.…”

Section: Discussionmentioning

confidence: 99%

“…36 Instead, as others have, we relied on epidemiologic evidence to select diagnoses that were most likely to be viral and omitted VRTI episodes associated with intervening bacterial diagnoses. 13,26,27 This definition excluded diagnoses that were potentially viral, such as pharyngitis or serous otitis media, but our goal was to identify infections for which the antibiotic prescribing rate should be zero.…”

Section: Discussionmentioning

confidence: 99%

Evidence-based prescribing of antibiotics for children: role of socioeconomic status and physician characteristics

Kozyrskyj

Dahl²,

Château³

et al. 2004

Canadian Medical Association Journal

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Background: Evidence-based guidelines for antibiotic use are well established, but nonadherence to these guidelines continues. This study was undertaken to determine child, household and physician factors predictive of nonadherence to evidencebased antibiotic prescribing in children. Methods: The prescription and health care records of 20 000Manitoba children were assessed for 2 criteria of nonadherence to evidence-based antibiotic prescribing during the period from fiscal year 1996 (April 1996 to March 1997) to fiscal year 2000: receipt of an antibiotic for a viral respiratory tract infection (VRTI) and initial use of a second-line agent for acute otitis media, pharyngitis, pneumonia, urinary tract infection or cellulitis. The likelihood of nonadherence to evidence-based prescribing, according to child demographic characteristics, physician factors (specialty and place of training) and household income, was determined from hierarchical linear modelling. Child visits were nested within physicians, and the most parsimonious model was selected at p < 0.05. Results: During the study period, 45% of physician visits for VRTI resulted in an antibiotic prescription, and 20% of antibiotic prescriptions were for second-line antibiotics. Relative to general practitioners, the odds ratio for antibiotic prescription for a VRTI was 0.51 (95% confidence interval [CI] 0.42-0.62) for pediatricians and 1.58 (95% CI 1.03-2.42) for other specialists. The likelihood that an antibiotic would be prescribed for a VRTI was 0.99 for each successive $10 000 increase in household income. Pediatricians and other specialists were more likely than general practitioners to prescribe second-line antibiotics for initial therapy. Both criteria for nonadherence to evidence-based prescribing were 40% less likely among physicians trained in Canada or the United States than among physicians trained elsewhere. Interpretation: The links that we identified between nonadherence to evidence-based antibiotic prescribing in children and physician specialty and location of training suggest opportunities for intervention. The independent effect of household income indicates that parents also have an important role.

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Outcomes After Judicious Antibiotic Use for Respiratory Tract Infections Seen in a Private Pediatric Practice

Cited by 41 publications

References 28 publications

Parent Expectations for Antibiotics, Physician-Parent Communication, and Satisfaction

Parent Expectations for Antibiotics, Physician-Parent Communication, and Satisfaction

The Pattern of Drug Use in Acute Fever by General Practitioners (GPs) in Pune City, India

Evidence-based prescribing of antibiotics for children: role of socioeconomic status and physician characteristics

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