Factors Associated with Prescribing Broad-Spectrum Antibiotics for Children with Upper Respiratory Tract Infections in Ambulatory Care Settings.

IF 1.7 Q2 PEDIATRICS Clinical Medicine Insights-Pediatrics Pub Date : 2018-07-02 DOI:10.1177/1179556518784300
Mohammad S Alzahrani, Mary K Maneno, Monika N Daftary, La'Marcus Wingate, Earl B Ettienne
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引用次数: 17

Abstract

Objectives: Broad-spectrum antibiotics are frequently prescribed for children with upper respiratory tract infections (URI). Excessive use of broad-spectrum antibiotics leads to the emergence of resistant bacteria. This study aimed to identify factors associated with prescribing broad-spectrum antibiotics among children younger than 18 years presenting with URI in outpatient settings.

Methods: We conducted a cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey-Outpatient Departments (NHAMCS-OPD) between 2006 and 2010. Descriptive statistics of visits from children with URI were estimated. Simple and multiple logistic regression analyses were used to identify socio-demographic and clinical characteristics associated with broad-spectrum antibiotic prescribing. We also completed a stratified analysis by age (⩽2 vs >2).

Results: A total of 4013 outpatient visits for children with URI from both NAMCS and NHAMCS-0PD data were examined. Broad-spectrum antibiotics were prescribed in 39% of the visits, accounting for an estimated 6.8 million visits annually. Multivariable analysis showed that visits in the South region (odds ratio [OR] = 2.38; 95% confidence interval [CI]: 1.38-4.10) compared with the West region and visits with diagnoses of acute sinusitis (OR = 2.77; 95% CI: 1.65-4.63) and acute otitis media (OR = 1.90; 95% CI: 1.32-2.74) compared with those with acute pharyngitis were associated with greater odds of broad-spectrum antibiotic prescribing.

Conclusions: The prescribing of broad-spectrum antibiotics is common for children with URI in ambulatory care settings. Diagnosis and management of URI remain a critical area for awareness campaigns promoting judicious use of antibiotics.

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在门诊护理环境中为上呼吸道感染儿童开具广谱抗生素处方的相关因素。
目的:广谱抗生素经常用于儿童上呼吸道感染(URI)。过度使用广谱抗生素会导致耐药细菌的出现。本研究旨在确定18岁以下儿童使用广谱抗生素的相关因素 在门诊环境中使用URI的年数。方法:我们对2006年至2010年间的全国门诊医疗调查(NAMCS)和全国医院门诊医疗调查门诊部(NHAMCS-OPD)进行了横断面分析。估计了URI儿童就诊的描述性统计数据。使用简单和多元逻辑回归分析来确定与广谱抗生素处方相关的社会人口统计学和临床特征。我们还完成了按年龄进行的分层分析(⩽2 vs>2)。结果:根据NAMCS和NHAMCS-0PD数据,共检查了4013例URI儿童门诊就诊。39%的就诊中使用了广谱抗生素,估计占6.8 每年访问量达百万人次。多变量分析显示,在南部地区就诊(比值比[OR] = 2.38;95%置信区间[CI]:1.38-4.10)与西部地区相比,以及诊断为急性鼻窦炎(OR = 2.77;95%可信区间:1.65-4.63)和急性中耳炎(OR = 1.90;95%可信区间:1.32-2.74)与急性咽炎患者相比,与更大的广谱抗生素处方几率相关。结论:在门诊护理环境中,对URI儿童开具广谱抗生素处方很常见。URI的诊断和管理仍然是促进明智使用抗生素的宣传活动的关键领域。
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