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

Abstract

BackgroundRespiratory tract infections (RTIs) in children are common and often result in antibiotic prescription despite their typically self-limiting course. AimTo assess the effectiveness of primary care based interventions to reduce antibiotic prescribing for children with RTIs. Design and settingSystematic review. Method MEDLINE ®, Embase, CINAHL ® , PsycINFO, and the Cochrane library were searched for randomised, cluster randomised, and nonrandomised studies testing educational and/or behavioural interventions to change antibiotic prescribing for children (<18 years) with RTIs. Main outcomes included change in proportion of total antibiotic prescribing or change in 'appropriate' prescribing for RTIs. Narrative analysis of included studies was used to identify components of effective interventions. ResultsOf 6301 references identified through database searching, 17 studies were included. Interventions that combined parent education with clinician behaviour change decreased antibiotic prescribing rates by between 6-21%; structuring the parent-clinician interaction during the consultation may further increase the effectiveness of these interventions. Automatic computerised prescribing prompts increased prescribing appropriateness, while passive information, in the form of waiting room educational materials, yielded no benefit. ConclusionConflicting evidence from the included studies found that interventions directed towards parents and/or clinicians can reduce rates of antibiotic prescribing. The most effective interventions target both parents and clinicians during consultations, provide automatic prescribing prompts, and promote clinician leadership in the intervention design. Keywordsanti-bacterial agents, children, prescriptions, primary health care, respiratory tract infections.e445 British Journal of General Practice, July 2013 (from inception through June 2012) were searched using terms for RTIs, children, parents, education, antibiotic prescription, and consultation (Table 1). One author screened titles and abstracts based on predefined inclusion criteria to identify relevant studies and reviewed reference lists and related citations of selected studies to identify additional references. Two authors reviewed the full-text of selected studies to determine inclusion. Disagreements were settled through discussions with a third author.Controlled studies were included that used a randomised, cluster randomised, non-randomised or one-group pre-and post-test design to assess the effectiveness of educational or behavioural interventions to change clinicians' antibiotic prescribing for acute RTIs in children (birth to 18 years) in primary care settings (family practice, emergency, or paediatric primary care). Outcomes of interest were change in proportion of antibiotic prescriptions issued for RTIs in children, or change in 'appropriate' antibiotic prescribing. Comparisons included no-treatment or alternate treatment controls. Studies were excluded if they were: from in-patient settings; evaluations of...

Ways of Optimizing Antimicrobial Therapy for the Treatment of Respiratory Diseases

“…Инфекции дыхательных путей являются наи-более частой причиной назначения АМТ, особенно в педиатрической практике: до 75% всех болезней у детей приходится на долю инфекций. Клиницисты часто назна-чают маленьким пациентам антибиотики, несмотря на то, что большинство из них имеет неопределенное зна-чение в терапии ОИДП, руководствуясь принципами возможной профилактики присоединения вторичной инфекции или под давлением родителей [12]. Так, в России исследователями было показано, что к 3-му году жизни более 60% детей получают до 5 курсов АМТ, а к 14 годам почти у 40% детей было 16 эпизодов приема антибиотиков [13,14].…”

Shared decision making in primary care: barriers and facilitators of shared decision making in the context of decreasing the use of unnecessary antibiotics for preschool children ages 3-5 with upper respiratory tract infections

“…Interventions to decrease unnecessary antibiotic use that are aimed at collaboration and communication between parents and clinicians are more successful than those aimed at parents or clinicians alone (Vodicka et al, 2013). Shared decision making effectively includes parents in the treatment and care of their child, which increases parental knowledge of URIs, and the best course of treatment (Hansen et al, 2015a).…”

“…According to the literature, PCPs who have effective communication and are engaged with the parents in their child's care have a 22% lower antibiotic prescription rate than those who do not (Hansen, et al, 2015a;Vodicka et al, 2013). As shared decision making requires excellent communication between PCPs and parents, this leads to the question: What are the barriers and facilitators to implementing shared decision making in relation to unnecessary antibiotic use in primary care settings when primary care providers are working with parents of preschool aged children with upper respiratory infections?…”

“…In order to decrease antibiotic use in the preschool population, PCPs must be able to collaborate and communicate with parents effectively regarding their child's health care (Vodicka et al, 2013). As primary care providers, family nurse practitioners (FNPs) have an important role in the care of families in British Columbia (BC).…”

“…Preschool aged children account for the highest rate of unnecessary antibiotic prescriptions (Alumran, Hou, & Hurst, 2013;Clavenna & Bonati, 2011;Vodicka, et al, 2013). Within the preschool population, unnecessary antibiotics are most commonly prescribed for viral upper respiratory infections (URIs) (Clavenna & Bonati, 2011;Kutty, 2011).…”