Antibiotic Use in Children with Acute Respiratory or Ear Infections: Prospective Observational Comparison of Anthroposophic and Conventional Treatment under Routine Primary Care Conditions.

Harald J Hamre,Helmut Kiene,Erik W Baars,Gunver S Kienle,Reinhard Schwarz,David S Riley,Anja Glockmann

doi:10.1155/2014/243801

Abstract

Children with acute respiratory or ear infections (RTI/OM) are often unnecessarily prescribed antibiotics. Antibiotic resistance is a major public health problem and antibiotic prescription for RTI/OM should be reduced. Anthroposophic treatment of RTI/OM includes anthroposophic medications, nonmedication therapy and if necessary also antibiotics. This secondary analysis from an observational study comprised 529 children <18 years from Europe (AT, DE, NL, and UK) or USA, whose caregivers had chosen to consult physicians offering anthroposophic (A-) or conventional (C-) treatment for RTI/OM. During the 28-day follow-up antibiotics were prescribed to 5.5% of A-patients and 25.6% of C-patients (P < 0.001); unadjusted odds ratio for nonprescription in A- versus C-patients 6.58 (95%-CI 3.45–12.56); after adjustment for demographics and morbidity 6.33 (3.17–12.64). Antibiotic prescription rates in recent observational studies with similar patients in similar settings, ranged from 31.0% to 84.1%. Compared to C-patients, A-patients also had much lower use of analgesics, somewhat quicker symptom resolution, and higher caregiver satisfaction. Adverse drug reactions were infrequent (2.3% in both groups) and not serious. Limitation was that results apply to children of caregivers who consult A-physicians. One cannot infer to what extent antibiotics might be avoided in children who usually receive C-treatment, if they were offered A-treatment.

Highlights

IntroductionAcute Respiratory Tract Infections and Otitis Media (RTI/ OM)
We have previously investigated these issues in a prospective observational study in primary care, showing low antibiotic use with at least comparable short-term resolution in adults and children treated for respiratory tract infections and otitis media (RTI/OM) by physicians offering treatment with anthroposophic medicine (AM, see Section 1.3), compared to physicians offering conventional treatment [53]
This was a secondary analysis of antibiotic prescription in children from a prospective observational study of primary care patients with acute RTI/OM, treated by physicians offering AM therapy (Aphysicians) or conventional therapy (C-physicians) under

Summary

Introduction

Acute Respiratory Tract Infections and Otitis Media (RTI/ OM). Acute respiratory tract infections and otitis media (RTI/OM) are frequent among children [1] and are commonly treated with antibiotics [2,3,4,5,6,7,8]. Antibiotic treatment as secondary prophylaxis in order to prevent complications of RTI/OM is difficult to justify in developed countries, where these complications are rare [13, 14]. Antibiotic use increases antimicrobial resistance [15], increases the recurrence rate of OM [16], and may be a risk factor for paediatric asthma [17,18,19,20], atopic eczema [21], and inflammatory bowel disease [22,23,24]. The European Commission has recently proposed an action plan against the rising threats from antimicrobial resistance, which is estimated to cause 25,000 human deaths as well as extra healthcare costs and productivity losses of at least 1.5 billion Euro annually [25]

Methods

Results

Discussion

Conclusion