title: Alarm signs and antibiotic prescription in febrile children in primary care: an observational cohort study.
abstract: BACKGROUND
  Although fever in children is often self-limiting, antibiotics are frequently prescribed for febrile illnesses. GPs may consider treating serious infections by prescribing antibiotics.
  
  
  OBJECTIVE
  To examine whether alarm signs and/or symptoms for serious infections are related to antibiotic prescription in febrile children in primary care.
  
  
  METHODS
  Observational cohort study involving five GP out-of-hours services.
  
  
  METHODS
  Clinical information was registered and manually recoded. Children (<16 years) with fever having a face-to-face contact with a GP were included. Children who were already using antibiotics or referred to secondary care were excluded. The relation between alarm signs and/or symptoms for serious infections and antibiotic prescription was tested using multivariate logistic regression.
  
  
  RESULTS
  Of the 8676 included patients (median age 2.4 years), antibiotics were prescribed in 3167 contacts (36.5%). Patient characteristics and alarm signs and/or symptoms positively related to antibiotic prescription were: increasing age (odds ratio [OR] = 1.03; 95% confidence interval [95% CI] = 1.02 to 1.05), temperature measured by GP (OR = 1.72; 95% CI = 1.59 to 1.86), ill appearance (OR = 3.93; 95% CI = 2.85 to 5.42), being inconsolable (OR = 2.27; 95% CI = 1.58 to 3.22), shortness of breath (OR = 2.58; 95% CI = 1.88 to 3.56), duration of fever (OR = 1.31; 95% CI = 1.26 to 1.35). Negative associations were found for neurological signs (OR = 0.45; 95% CI = 0.27 to 0.76), signs of urinary tract infection (OR = 0.63; 95% CI = 0.49 to 0.82), and vomiting and diarrhoea (OR = 0.65; 95% CI = 0.57 to 0.74). These variables explained 19% of the antibiotic prescriptions.
  
  
  CONCLUSIONS
  Antibiotics are often prescribed for febrile children. These data suggest that treatment of a supposed serious bacterial infection is a consideration of GPs. However, the relatively low explained variation indicates that other considerations are also involved.
authors.affiliation: Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Gijs
authors.initials: G
authors.lastname: Elshout
authors.forename: Yvette
authors.initials: Y
authors.lastname: van Ierland
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Bohnen
authors.forename: Marcel
authors.initials: M
authors.lastname: de Wilde
authors.forename: Rianne
authors.initials: R
authors.lastname: Oostenbrink
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
authors.forename: Marjolein Y
authors.initials: MY
authors.lastname: Berger
mesh_terms: D039602:After-Hours Care; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004417:Dyspnea / Q000188:drug therapy*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D014552:Urinary Tract Infections / Q000188:drug therapy*; D014839:Vomiting / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents