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Am Fam Physician. 2003;67(6):1388

The inappropriate and frequent use of antibiotics in children with upper respiratory tract infections has contributed to the increased prevalence of bacteria species that are resistant to antimicrobial agents. Antibiotics are given to approximately three fourths of children who present to outpatient facilities with upper respiratory tract conditions. Because of the issues concerning the overuse of antibiotics, the Centers for Disease Control and Prevention, along with the American Academy of Pediatrics, published a document that reviews the appropriate use of antibiotics in children with upper respiratory conditions. The recommendations include not using antibiotics to treat conditions that are unlikely to respond to these agents and, when indicated, using narrow- instead of broad-spectrum antibiotics. To date, no studies have determined if the publication of these recommendations has changed antibiotic prescribing habits for upper respiratory tract conditions. Nash and associates determined the rate of appropriate use of antibiotics for children with bronchitis, viral upper respiratory tract infections, sinusitis, otitis media, and pharyngitis, and if this use has changed over recent years. In addition, they determined factors that are associated with the use of inappropriate antibiotic therapy.

The setting for the study was office-based physician practices that provide primary care for patients younger than 18 years. The authors used the National Ambulatory Medical Care Survey to determine the antibiotic prescribing habits of these physicians. Physicians were asked to record information from patient encounters for one week that was randomly selected during the year. Data were analyzed from 1995 through 1998. The main outcome measured was whether antibiotics were used appropriately in children with upper respiratory tract infections.

According to the results, antibiotics were inappropriately prescribed for viral upper respiratory tract infections and bronchitis in approximately 39 percent of patients. The odds declined during the study so that by the end of the study, children were 0.69 times less likely to receive inappropriate antibiotic therapy than children in the early phase of the study. Pediatricians were less likely to inappropriately prescribe antibiotics for these illnesses than were family physicians/general physicians (33.9 versus 49.0 percent, respectively). In addition, by the end of the study, children with sinusitis or otitis media were 0.3 times less likely to receive inappropriate antibiotic therapy. In handling these illnesses, there was no difference between the specialties.

The authors conclude that while the inappropriate use of antibiotics in children with upper respiratory infections has slowly improved, the practice is still common. Any intervention to improve antibiotic use should concentrate on not treating viral upper respiratory tract infections or bronchitis with antibiotics. The authors add that education should be directed not only at physicians but also at parents and patients to dampen their enthusiasm for antibiotic therapy.

editor’s note: Over the past few years, there has been a substantial effort to reduce the inappropriate use of antibiotics in viral illnesses that tend to be self-limiting. According to Nash and associates, despite these efforts a substantial number of patients still receive inappropriate antibiotic therapy. To reduce the incidence of resistant bacteria, physicians must reserve antibiotic therapy for bacterial infections and avoid the trap of treating viral illnesses. Physicians must educate their patients and, in the case of children, their parents, about when antibiotic therapy is appropriate and when it is not. This educational effort can assist physicians in reducing unnecessary antibiotic use and slow the progress of bacterial resistance.—K.E.M.

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