Inappropriate antibiotic prescription to children with acute respiratory infection in Brazil.
OBJECTIVE
To determine the rate of inappropriate antibiotic prescription and to describe the types of antibiotics prescribed by health workers to children with acute respiratory infection (ARI).


METHODS
Cross-sectional survey conducted in 6 state capitals of Brazil.


METHODS
A representative sample of facilities was selected in each state using a cluster sampling method based on the mean number of visits of children less than 5 years of age. In each facility, consultations were observed and children were reassessed following standard guidelines. Health worker s diagnosis and treatment were compared with a gold standard and inappropriate antibiotic prescriptions noted.


RESULTS
1565 children with ARI from 156 health facilities (73% health centers) were included in study. Most children had a common cold (77.5%). Antibiotics were inappropriately prescribed in 9.2% (95% CI: 7.8, 10.7) of ARI cases (range: 2.8% to 25%). Most frequently prescribed antibiotics were those recommended by the ARI Program. Seventy-six percent of health workers explained to guardians how to use antibiotics at home and 3.9% demonstrated the first dose. Antibiotics were available in 84% of health facilities.


CONCLUSIONS
Inappropriate prescription of antibiotics varied geographically in Brazil. More training and supervision is needed to decrease it.
da Cunha
Antonio Jose Ledo Alves
AJ
Department of Pediatrics IPPMG - Universidade Federal do Rio de Janeiro, Brazil. acunha@ufrj.br
Amaral
Joao
J
e Silva
Maria Anice Fontenele
MA
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001938:Brazil; D002675:Child, Preschool; D016000:Cluster Analysis; D003139:Common Cold / Q000188:drug therapy; D003430:Cross-Sectional Studies; D006801:Humans; D007223:Infant; D011014:Pneumonia / Q000188:drug therapy; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012141:Respiratory Tract Infections / Q000188:drug therapy*
D000900:Anti-Bacterial Agents