Why do children hospitalised with pneumonia not receive antibiotics in primary care?

Harnden, Anthony; Mant, David; Emery, Diane P; Coster, Gregor

doi:10.1136/archdischild-2011-300604

Cited by 15 publications

(26 citation statements)

References 27 publications

(24 reference statements)

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“…In a previous New Zealand study, Grant et al observed that 61% of children aged less than 5 years, who were seen in primary care and subsequently hospitalised with community‐acquired pneumonia, received no antibiotics prior to admission . Although this was not associated with increased disease severity, these children were more likely to be bacteraemic.…”

Section: Discussionmentioning

confidence: 99%

Incidence, aetiology and outcome of pleural empyema and parapneumonic effusion from 1998 to 2012 in a population of New Zealand children

Mahon¹,

Walker²,

Drage³

et al. 2016

J Paediatrics Child Health

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Section: Discussionmentioning

confidence: 99%

Incidence, aetiology and outcome of pleural empyema and parapneumonic effusion from 1998 to 2012 in a population of New Zealand children

Mahon¹,

Walker²,

Drage³

et al. 2016

J Paediatrics Child Health

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“…There is particular concern regarding overuse of antibiotics for children with self-limiting illness [ 7 , 8 ]. At the same time, severe infections are sometimes missed by clinicians and prescriptions not issued [ 9 , 10 ]. Similarly, non-specific abdominal pain in childhood is often under-investigated and over-medicated in primary care [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care

Lucas

Cabral²,

Hay³

et al. 2015

Scandinavian Journal of Primary Health Care

159

164

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Objectives. To investigate the views of parents, clinicians, and children pertaining to prescribing decisions for acute childhood infection in primary care. Methods. A systematic review of qualitative studies. Meta-ethnographic methods were used, with data drawn from the primary studies in an interpretive analysis. Results. A total of 15 studies met the inclusion criteria. The literature was dominated by concerns about antibiotic over-prescription. Children's views were not reported. Clinicians prescribed antibiotics when they felt pressured by parents or others (e.g. employers) to do so, when they believed there was a clear clinical indication, but also when they felt uncertain of clinical or social outcomes they prescribed “just in case”. Parents wanted antibiotics when they felt they would improve the current illness, and when they felt pressure from daycare providers or employers. Clinicians avoided antibiotics when they were concerned about adverse reactions or drug resistance, when certain they were not indicated, and when there was no perceived pressure from parents. Parents also wished to avoid adverse effects of antibiotics, and did not want antibiotics when they would not relieve current symptoms. Some parents preferred to avoid medication altogether. Within paediatric consultations, parents sought a medical evaluation and decision. Primary care clinicians want satisfied parents and short consultations. Conclusions. Antibiotic prescriptions for childhood infections in primary care often result from “just in case” prescribing. These findings suggest that interventions which reduce clinician uncertainty regarding social or clinical outcomes and provide strategies to meet parents’ needs within a short consultation are most likely to reduce antibiotic prescribing.

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“…However, delays in care-seeking often occur and can be related to cost, non-recognition of the severity of illness, differences in the perception of the cause of disease, or geographic barriers [8-11]. Additionally, poor healthcare infrastructure and/or lack of appropriate care and medicine contribute to delays [12].…”

Section: Introductionmentioning

confidence: 99%

“…When needed, antibiotic therapy has dramatic effects on child survival; case-fatality rates for treated ALRI are under 1% while untreated ALRI case-fatality rates may reach over 10% [16]. However, there are a number of barriers to receiving appropriate antibiotics at the clinic level, including stock-outs, understaffing, prescribing patterns of health workers, and diagnostic overlaps with other infections [11,12,17,18]. …”

Section: Introductionmentioning

confidence: 99%

Care-seeking and appropriate treatment for childhood acute respiratory illness: an analysis of Demographic and Health Survey and Multiple Indicators Cluster Survey datasets for high-mortality countries

et al. 2014

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BackgroundAcute lower respiratory illness (ALRI) is a major global cause of morbidity and mortality among children under 5. Antibiotic treatment for ALRI is inexpensive and decreases case fatality, but care-seeking patterns and appropriate treatment vary widely across countries. This study sought to examine patterns of appropriate treatment and estimate the burden of cases of untreated ALRI in high mortality countries.MethodsThis study used cross-sectional survey data from the Phase 5/Phase 6 DHS and MIC3/MICS4 for 39 countries. We analyzed care-seeking patterns and antibiotic treatment based on country-level trends, and estimated the burden of untreated cases using country-level predictors in a general linear model.ResultsAccording to this analysis, over 66 million children were not treated with antibiotics for ALRI in 2010. Overall, African countries had a lower proportion of mothers who sought care for a recent episode of ALRI (41% to 86%) relative to Asian countries (75% to 87%). Seeking any care for ALRI was inversely related to seeking public sector care. Treatment with antibiotics ranged from 8% in Nepal to 87% in Jordan, and was significantly associated with urban residence.ConclusionsUntreated ALRI remains a substantial problem in high mortality countries. In Asia, the large population numbers lead to a high burden of children with untreated ALRI. In Africa, care-seeking behaviors and access to care issues may lead to missed opportunities to treat children with antibiotics.

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Why do children hospitalised with pneumonia not receive antibiotics in primary care?

Cited by 15 publications

References 27 publications

Incidence, aetiology and outcome of pleural empyema and parapneumonic effusion from 1998 to 2012 in a population of New Zealand children

Incidence, aetiology and outcome of pleural empyema and parapneumonic effusion from 1998 to 2012 in a population of New Zealand children

A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care

Care-seeking and appropriate treatment for childhood acute respiratory illness: an analysis of Demographic and Health Survey and Multiple Indicators Cluster Survey datasets for high-mortality countries

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