title: Antibiotic prescription in febrile children: a cohort study during out-of-hours primary care.
abstract: BACKGROUND
  Fever is common in children and often self-limiting, nevertheless antibiotics are frequently prescribed. We determined how often antibiotics were prescribed in children presenting with fever at a family physicians' out-of-hours service and established the children's signs and symptoms related to antibiotic prescriptions.
  
  
  METHODS
  Children aged 3 months to 6 years with fever as the main reason for contact.
  
  
  RESULTS
  Of the 443 included children, 322 children had a face-to-face contact at the out-of-hours service. Of these, 117 (36.3%) were prescribed antibiotics, that is, 26.5% of the total study population. Concerned parents (OR, 2.02; 95% CI, 1.06-3.58), ill appearance (3.26; 1.30-8.20), earache resulting in altered behavioral or sleeping patterns (2.59; 1.06-6.30), signs of throat infection (2.37; 1.35-4.15), and decreased urine production (2.00; 1.17-3.41) were positively associated with antibiotic prescription. A negative association was found for age 3 to 6 months (0.17; 0.03-0.74) and temperature (0.52; 0.37-0.71).
  
  
  CONCLUSIONS
  Antibiotics were prescribed in 1 out of 4 febrile children whose parents contacted the out-of-hours service. Items associated with antibiotic prescription provide insight into the family physicians' decision-making process when assessing children with fever. These can be used as targets for strategies to diminish antibiotic prescription.
authors.affiliation: Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Gijs
authors.initials: G
authors.lastname: Elshout
authors.forename: Marijke
authors.initials: M
authors.lastname: Kool
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Van der Wouden
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Marjolein Y
authors.initials: MY
authors.lastname: Berger
mesh_terms: D039602:After-Hours Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000188:drug therapy*; D019538:Health Care Surveys; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care
chemical_list: D000900:Anti-Bacterial Agents