
Ear infections, a general practitioner (GP) as a prescriber, and rural settings were identified as primary drivers of inappropriate antibiotic prescribing in children treated in ambulatory care in high-income countries, according to a study published yesterday in the Journal of Antimicrobial Chemotherapy.
For the study, Belgian researchers reviewed 40 articles reporting on 30 different factors and their association with inappropriate prescribing in acutely ill children receiving ambulatory care in 15 high-income countries. They included cross-sectional studies, prospective and retrospective cohort studies, and reports from health organizations.
Appropriateness covered a range of definitions, including whether the class of prescribed antibiotic or dose was appropriate, and whether the diagnosis justified the antibiotic prescription. Factors and their association with inappropriate prescribing were categorized as patient-level, prescriber-level, environment-level, or miscellaneous.
Priorities for antibiotic stewardship
A meta-analysis of the pooled results found that diagnosis of acute otitis media (ear infection; pooled odds ratio [OR], 2.02; 95% confidence interval [CI], 0.54 to 7.48) was associated with more inappropriate prescribing compared with upper respiratory tract infections, and that GPs had 1.38 higher odds (95% CI, 1.00 to 1.89) of inappropriate prescribing compared with pediatricians. Odds of inappropriate prescribing in rural settings were 1.48 times higher (95% CI, 1.08 to 2.02) than in urban settings.
The researchers also found that older patient age and respiratory tract infection diagnosis have a tendency to be positively associated with inappropriate antibiotic prescribing, but pooling of the studies was not possible.
"Therefore, it is recommended that antimicrobial stewardship programmes prioritize these specific situations," the study authors wrote. "Several examples of antimicrobial stewardship actions include decision-support tools, audit and feedback, support for adhering to antimicrobial guidelines, fixed pack dispensing, and public awareness campaigns."