Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: a systematic review and meta-analysis.
BACKGROUND
Respiratory tract infections (RTIs) are common in children and generally self-limiting, yet often result in consultations to primary care. Frequent consultations divert resources from care for potentially more serious conditions and increase the opportunity for antibiotic overuse. Overuse of antibiotics is associated with adverse effects and antimicrobial resistance, and has been shown to influence how patients seek care in ensuing illness episodes.


RESULTS
We conducted a systematic review and meta-analysis to assess the effectiveness of interventions directed towards parents or caregivers which were designed to influence consulting and antibiotic use for respiratory tract infections (RTIs) in children in primary care. Main outcomes were parental consulting rate, parental knowledge, and proportion of children subsequently consuming antibiotics. Of 5,714 references, 23 studies (representing 20 interventions) met inclusion criteria. Materials designed to engage children in addition to parents were effective in modifying parental knowledge and behaviour, resulting in reductions in consulting rates ranging from 13 to 40%. Providing parents with delayed prescriptions significantly decreased reported antibiotic use (Risk Ratio (RR) 0.46 (0.40, 0.54); moreover, a delayed or no prescribing approach did not diminish parental satisfaction.


CONCLUSIONS
IN ORDER TO BE MOST EFFECTIVE, INTERVENTIONS TO INFLUENCE PARENTAL CONSULTING AND ANTIBIOTIC USE SHOULD: engage children, occur prior to an illness episode, employ delayed prescribing, and provide guidance on specific symptoms. These results support the wider implementation of interventions to reduce inappropriate antibiotic use in children.
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States of America.
Talley
T
Andrews
Matthew
M
Thompson
David I
DI
Buckley
Carl
C
Heneghan
Rick
R
Deyo
Niamh
N
Redmond
Patricia J
PJ
Lucas
Peter S
PS
Blair
Alastair D
AD
Hay
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000628:therapy*
D000900:Anti-Bacterial Agents