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Am Fam Physician. 2006;73(9):1619-1634

Clinical Question: Does more cautious prescribing of antibiotics for sore throat increase the number of children with serious complications?

Setting: Population-based

Study Design: Ecologic

Synopsis: In the United Kingdom, as in the United States, physicians are prescribing fewer antibiotics for acute respiratory conditions in children. This is a laudable trend, but some researchers have speculated that the use of fewer antibiotics may increase the risk of rare but serious problems such as mastoiditis, peritonsillar abscess, and rheumatic fever. The authors searched for related studies using data from a national database of drugs dispensed by pharmacists, a primary care database for 130 practices, and a database of hospital admissions. They found that antibiotic prescribing by physicians declined by approximately 35 percent between 1993 and 1999 and then leveled off; the number of prescriptions filled continued to decline by another 9 percent in the next four years, probably because of an increase in the practice of delaying prescriptions to reduce inappropriate antibiotic usage.

During the same period (1993 to 2003), there was no change in the rates of hospital admission for peritonsillar abscess or rheumatic fever, but there was a 19 percent rise in the rate of admission for mastoidectomy. However, there was a trend toward a declining number of episodes of mastoidectomy seen in general practices. Also, most of the increase in hospital episodes of mastoidectomy were in children younger than four years, an age when otitis media is most common.

Bottom Line: More judicious prescribing of antibiotics for childhood respiratory infection has not increased the number of episodes of peritonsillar abscess or rheumatic fever. The effect on mastoidectomy is unclear, but a clinically important increase seems unlikely. (Level of Evidence: 2c)

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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