title: Primary care management of respiratory tract infections in Dutch preschool children.
abstract: OBJECTIVE
  To determine age-specific antibiotic prescription and referral rates in preschool children diagnosed with acute respiratory tract infection (RTI) in primary care.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Research database of the Netherlands University Medical Center Utrecht Primary Care Network.
  
  
  METHODS
  All children aged 0-5 years within the database were included, covering 1998 to 2002 (18,801 child-years).
  
  
  METHODS
  Antibiotic prescription and referral rates were determined as percentage of children with at least one prescription or referral within a year, as total number of prescriptions per 1000 child-years, and as percentage of all RTI episodes.
  
  
  RESULTS
  Antibiotics, mostly beta-lactam (80%) and macrolides (16%), were prescribed in 35% of RTI episodes. Annually 13% of the children received at least one antibiotic following an RTI. Antibiotics were prescribed in more than half of episodes of LRTI, sinusitis, AOM, and acute tonsillitis, and in 12-15% of episodes of asthma exacerbation, acute laryngitis, influenza acute, and acute upper respiratory infection (including common cold and pharyngitis). Almost 98% of RTIs were managed in primary care. On average 1% of the children were referred to a paediatrician or ENT specialist following RTI per year, especially after AOM (59% of referrals). Compared with older children, those under two years of age were more often treated with antibiotics (relative risk [RR] 1.4, 95% CI 1.3-1.6) and referred (RR 2.3; 95% CI 1.8-3.0).
  
  
  CONCLUSIONS
  In the Netherlands most episodes of RTIs in preschool children were managed in primary care and this often involves prescription of antibiotics. Children younger than two years of age receive more often antibiotics for RTI and are also referred more, especially for AOM.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. A.G.S.C.Jansen@umcutrecht.nl
authors.forename: Angelique G S C
authors.initials: AG
authors.lastname: Jansen
authors.forename: Elisabeth A M
authors.initials: EA
authors.lastname: Sanders
authors.forename: Anne G M
authors.initials: AG
authors.lastname: Schilder
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.forename: Vanya F G M
authors.initials: VF
authors.lastname: de Jong
authors.forename: Eelko
authors.initials: E
authors.lastname: Hak
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002675:Child, Preschool; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005194:Family Practice; D006801:Humans; D007223:Infant; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents