Interventions to Influence Consulting and Antibiotic Use for Acute Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

Talley Andrews,Patricia J Lucas,Peter S Blair,Matthew Thompson,Carl Heneghan,Rick Deyo,Alastair D Hay,David I Buckley,Niamh Redmond,Daniel Morgan

doi:10.1371/journal.pone.0030334

Abstract

BackgroundRespiratory tract infections (RTIs) are common in children and generally self-limiting, yet often result in consultations to primary care. Frequent consultations divert resources from care for potentially more serious conditions and increase the opportunity for antibiotic overuse. Overuse of antibiotics is associated with adverse effects and antimicrobial resistance, and has been shown to influence how patients seek care in ensuing illness episodes.Methodology/Principal FindingsWe conducted a systematic review and meta-analysis to assess the effectiveness of interventions directed towards parents or caregivers which were designed to influence consulting and antibiotic use for respiratory tract infections (RTIs) in children in primary care. Main outcomes were parental consulting rate, parental knowledge, and proportion of children subsequently consuming antibiotics. Of 5,714 references, 23 studies (representing 20 interventions) met inclusion criteria. Materials designed to engage children in addition to parents were effective in modifying parental knowledge and behaviour, resulting in reductions in consulting rates ranging from 13 to 40%. Providing parents with delayed prescriptions significantly decreased reported antibiotic use (Risk Ratio (RR) 0.46 (0.40, 0.54); moreover, a delayed or no prescribing approach did not diminish parental satisfaction.ConclusionsIn order to be most effective, interventions to influence parental consulting and antibiotic use should: engage children, occur prior to an illness episode, employ delayed prescribing, and provide guidance on specific symptoms. These results support the wider implementation of interventions to reduce inappropriate antibiotic use in children.

Highlights

Respiratory tract infections (RTIs) are common in children and drive the majority of antibiotic prescribing for this population [1]
The key finding of our review for clinicians is that interventions can reduce the number of consultations for RTIs by 10 to 40%, and that use of antibiotics can be reduced by up to half through delayed prescribing
Our findings have important implications for the content, format, and Outcome Parental knowledge related to consulting Parental knowledge or attitudes related to antibiotic use Parental consulting

Summary

Introduction

Respiratory tract infections (RTIs) are common in children and drive the majority of antibiotic prescribing for this population [1]. Overuse of antibiotics in primary care contributes to resistance [10], reducing the benefits of antibiotics, and can lead to subsequent ‘‘medicalisation of illness’’ where patients believe they need to consult when similar symptoms recur [11] – thereby creating a ‘vicious cycle’. Public education campaigns are ongoing in many countries [13], targeted efforts are needed at the practice and patient level to reduce population-wide risk of antibiotic resistance. Respiratory tract infections (RTIs) are common in children and generally self-limiting, yet often result in consultations to primary care. Overuse of antibiotics is associated with adverse effects and antimicrobial resistance, and has been shown to influence how patients seek care in ensuing illness episodes

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