title: Outcomes after judicious antibiotic use for respiratory tract infections seen in a private pediatric practice.
abstract: BACKGROUND
  Most respiratory tract infections (RTIs) in children have a viral cause, they resolve on their own, and antibiotics need not be prescribed.
  
  
  OBJECTIVE
  We sought to provide evidence that judicious antibiotic use can be accomplished in private pediatric practice without observing an increase in return office visits or in the rate of bacterial infections that may follow.
  
  
  METHODS
  This was a prospective 12-month study from July 1, 1996 through June 30, 1997. On the same 1 day each week, a representative convenience sample of acute respiratory tract illness patients was enrolled, and laboratory studies performed as appropriate, including viral cultures on all. Children were then followed for 30 days to ascertain the outcomes of not prescribing antibiotics except when specific bacterial infections were present at the initial visit.
  
  
  RESULTS
  Three hundred eighty-three children were enrolled; 293 (77%) did not receive antibiotics at the enrollment visit. Ninety children (23%) received antibiotics based on a diagnosis of acute otitis media (n = 53), acute streptococcal tonsillopharyngitis (n = 18), or other presumed or documented bacterial infections (n = 19). An unscheduled return visit related to the initial visit occurred for 86 (29%) of the 293 children not receiving antibiotics initially and in 40 (44%) of 90 children receiving antibiotics initially. Eighty-seven children (23%) had positive viral culture results. The most frequently isolated viruses were adenovirus, enterovirus, parainfluenzae virus, and influenza virus.
  
  
  CONCLUSIONS
  Children with RTIs without a concomitant presumed or proven bacterial infection do not require antibiotics. In this busy office practice, >75% of the children presenting with an RTI did not have a presumed or proven bacterial infection. These children did not have a higher rate of return office visits or an increase in bacterial infections. This reinforces the judicious use of antibiotics in managing children with RTIs.outcomes, antibiotic, respiratory infections.
authors.affiliation: Elmwood Pediatric Group, Department of Microbiology/Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA. mepo@uhura.cc.rochester.edu
authors.forename: M E
authors.initials: ME
authors.lastname: Pichichero
authors.forename: J L
authors.initials: JL
authors.lastname: Green
authors.forename: A B
authors.initials: AB
authors.lastname: Francis
authors.forename: S M
authors.initials: SM
authors.lastname: Marsocci
authors.forename: M L
authors.initials: ML
authors.lastname: Murphy
mesh_terms: D000372:Agglutination Tests; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008297:Male; D009518:New York; D010818:Practice Patterns, Physicians'; D011331:Private Practice; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology / Q000821:virology
chemical_list: D000900:Anti-Bacterial Agents