Abstract
BackgroundTo investigate determinants of antibiotic prescription in paediatric care, as a first step of a multilevel intervention to improve prescribing for common respiratory tract infections (RTIs) in a northern Italian region with high antibiotic prescription rate.MethodsA two-step survey was performed: in phase I, knowledge, and attitudes were explored involving all family and hospital paediatricians of Emilia-Romagna and a sample of parents. In phase II, patient care practices were explored in a stratified random sample of visits, both in hospitals and family physician's clinics; parent expectations were investigated in a sub-sample of these visits.ResultsOut of overall 4352 visits for suspected RTIs, in 38% of children an antibiotic was prescribed. Diagnostic uncertainty was perceived by paediatricians as the most frequent cause of inappropriate prescription (56% of 633 interviewed paediatricians); but, rapid antigen detecting tests was used in case of pharyngitis/pharyngotonsillitis by 36% and 21% of family and hospital paediatricians only. More than 50% of paediatricians affirmed to not adopt a "wait and see strategy" in acute otitis. The perceived parental expectation of antibiotics was not indicated by paediatricians as a crucial determinant of prescription, but this perception was the second factor most strongly associated to prescription (OR = 12.8; 95% CI 10.4 - 15.8), the first being the presence of othorrea. Regarding parents, the most important identified factors, potentially associated to overprescribing, were the lack of knowledge of RTIs and antibiotics (41% of 1029 parents indicated bacteria as a possible cause of common cold), and the propensity to seek medical care for trivial infections (48% of 4352 children accessing ambulatory practice presented only symptoms of common cold).ConclusionA wide gap between perceived and real determinants of antibiotic prescription exists. This can promote antibiotic overuse. Inadequate parental knowledge can also induce inappropriate prescription. The value of this study is that it simultaneously explored determinants of antimicrobial prescribing in an entire region involving both professionals and parents.
Highlights
To investigate determinants of antibiotic prescription in paediatric care, as a first step of a multilevel intervention to improve prescribing for common respiratory tract infections (RTIs) in a northern Italian region with high antibiotic prescription rate
In Emilia-Romagna, a northern Italian region of 4 million inhabitants, the regional prescription rate, at the community level, in 2005 was 1222 prescriptions/1000/year of systemic antibiotics in children aged 014, with amoxicillin associated with inhibitors of betalactamase, cephalosporins, macrolides and broad-spectrum penicillins being the most prescribed antibiotic classes (33%, 24%, 21% and 20% of all prescriptions, respectively) [7]
30% of Family paediatricians (FPs) worked in association with other paediatricians; 18% had a secretary or nurse helping with ambulatory activities; 57% used software to manage patient data
Summary
To investigate determinants of antibiotic prescription in paediatric care, as a first step of a multilevel intervention to improve prescribing for common respiratory tract infections (RTIs) in a northern Italian region with high antibiotic prescription rate. In Emilia-Romagna, a northern Italian region of 4 million inhabitants, the regional prescription rate, at the community level, in 2005 was 1222 prescriptions/1000/year of systemic antibiotics in children aged 014, with amoxicillin associated with inhibitors of betalactamase, cephalosporins, macrolides and broad-spectrum penicillins being the most prescribed antibiotic classes (33%, 24%, 21% and 20% of all prescriptions, respectively) [7]. Data from the Regional surveillance system of antimicrobial resistance show high prevalence of erythromycin resistance in Streptococcus pneumoniae (40%) and Streptococcus pyogenes (21%) isolated from respiratory tract cultures of resident children in 2006, and medium prevalence level of penicillin non susceptible
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