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Antimicrobials prescribed excessively to treat acute respiratory tract infections
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Antimicrobials were prescribed for acute respiratory tract infections nearly twice as often as expected, according to study findings in Pediatrics.
Matthew P. Kronman, MD, MSCE, of the University of Washington in Seattle, and colleagues conducted a meta-analysis of articles published between 2000 and 2012 on the microbial etiology of acute otitis media, sinusitis, bronchitis, upper respiratory infection and pharyngitis among previously healthy children. Researchers used data from the National Ambulatory Medical Care Survey to determine national estimates for antimicrobial prescribing for acute respiratory tract infections.
Analysis included 12 studies on AOM, 34 articles on sinusitis, 15 articles on bronchitis and upper respiratory infections, and 11 articles on pharyngitis.
Bacteria were isolated during 64.7% of AOM episodes. Of these, Streptococcus pneumoniae was isolated in 44.1%, Haemophilus influenzae in 36.3%, Moraxella catarrhalis in 7.5% and Streptococcus pyogenes in 5.5%. Thirty-five percent of bacterial isolates from acute otitis media episodes required second-line therapy.
Acute respiratory tract infections had an average annual rate of 525 per 1,000 population and accounted for 27% of all ambulatory clinic visits to pediatricians and general or family practitioners.
Sinusitis visits increased by 0.05% per year and upper respiratory infection visits decreased by 0.2% per year during the study period.
Annual antimicrobial prescribing rate ranged from 51.5% to 61.6% among acute respiratory tract infection visits between 2000 and 2010. Average annual antimicrobial prescribing rates were 88.8% for sinusitis, 85.9% for AOM, 71.5% for bronchitis, 56.9% for pharyngitis and 24.4% for upper respiratory infection.
Nearly 60% of acute respiratory tract infection visits resulted in antimicrobial prescriptions overall compared with an expected prescribing rate of 27.4%. Researchers estimated 11.4 million preventable antimicrobial prescriptions for acute respiratory tract infections occurred each year.
An average of 59% of acute respiratory tract infection visits received first-line therapy. Individually, 75.6% of upper respiratory infection visits received first-line therapy, 58.5% of pharyngitis visits, 55% of sinusitis visits, 46.2% of AOM visits and 28.5% of bronchitis visits.
“Future interventions are needed to reduce ongoing unnecessary antimicrobial prescribing rates for these common childhood infections,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Leonard R. Krilov, MD, FAAP
Antibiotic stewardship programs aimed at maximizing antibiotic usage have focused on selection of the most appropriate, narrow spectrum agents, length of therapy, and intravenous to oral conversion in the hospital setting. But outpatient antimicrobial stewardship is equally important. I believe the most effective approach to minimize unnecessary antibiotic administration, especially in pediatrics where much of antibiotic use is empiric and the causative organism of the child’s infection is often not obtained, is to emphasize critical diagnosis of the illness as likely bacterial in nature before prescribing therapy.
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