title: ["Antibiotics only when necessary" campaign in the Alpes-Maritimes district: no negative impact on invasive infections in children in the community 1998-2003].
abstract: OBJECTIVE
  A multidisciplinary group (for the study and prevention of infections in children, GEPIE) conducted a local public health campaign to improve antibiotic prescribing in pediatric outpatient care in the Alpes-Maritimes district. This campaign included peer-conducted academic-detailing (educational outreach) visits in 2000 and 2003. Practitioners often report during both focus groups and the GEPIE visits that they prescribe antibiotics because of a fear of subsequent complications. This study therefore sought to explore the trends in invasive diseases related to bacterial respiratory pathogens.
  
  
  METHODS
  A retrospective survey examined the incidence in the district of invasive infections due to Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, and Neisseria meningitidis from 1998 through 2003 among children aged 1 month to 15 years. All local laboratories were asked for all reports of blood cultures (as well as spinal, synovial, pericardiac, peritoneal, and pleural fluid cultures) positive for these bacteria in the study population over the study period. Resistance and serotype data were recorded.
  
  
  RESULTS
  Over the 6-year study period, there were 113 cases of invasive infections: 64% due to S. pneumoniae, 26% to N. meningitidis, 6% to H. influenzae, and 4% to S. pyogenes. There was no statistically significant difference in the annual average incidence rate before and during the campaign. The overall incidence rate was 11.2 cases per 100,000; meningitis accounted for 4.2, and invasive pneumococcal diseases 7.2 (42.7 per 100,000 children younger than 2 years). Pneumococcal resistance rates to penicillin and erythromycin did not change significantly.
  
  
  CONCLUSIONS
  Two local cross-sectional studies at daycare centers in 1999 and 2002 showed a 9% reduction in the proportion of children who received antibiotics. The stability of invasive infection in children and of bacterial resistance during the campaign is reassuring. The campaign's risk/benefit ratio appears positive.
  
  
  CONCLUSIONS
  These results encourage continuing promotion of rational antibiotic prescribing and ought to allay practitioners' fears about the consequences of prescribing antibiotics less often.
authors.affiliation: Laboratoire, Centre hospitalier d'Antibes, F-06600 Antibes, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Blanc
authors.forename: Pascale
authors.initials: P
authors.lastname: Bruno-Bazureault
authors.forename: Arnaud
authors.initials: A
authors.lastname: Malicki
authors.forename: Frédéric
authors.initials: F
authors.lastname: Berthier
authors.forename: Brigitte
authors.initials: B
authors.lastname: Dunais
authors.forename: Pia
authors.initials: P
authors.lastname: Touboul
authors.forename: Philippe
authors.initials: P
authors.lastname: Hofliger
authors.forename: Thierry
authors.initials: T
authors.lastname: Fosse
authors.forename: Christian
authors.initials: C
authors.lastname: Pradier
authors.forename: Pierre
authors.initials: P
authors.lastname: Dellamonica
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents