Clinical predictors of antibiotic prescribing for acutely ill children in primary care: an observational study.
BACKGROUND
Antibiotic overuse and inappropriate prescribing drive antibiotic resistance. Children account for a high proportion of antibiotics prescribed in primary care.


OBJECTIVE
To determine the predictors of antibiotic prescription in young children presenting to UK general practices with acute illness.


METHODS
Prospective observational study in general practices in Wales.


METHODS
A total of 999 children were recruited from 13 practices between March 2008 and July 2010. Multilevel, multivariable logistic regression analysis was performed to determine predictors of antibiotic prescribing.


RESULTS
Oral antibiotics were prescribed to 261 children (26.1%). Respiratory infections were responsible for 77.4% of antibiotic prescriptions. The multivariable model included 719 children. Children were more likely to be prescribed antibiotics if they were older (odds ratio [OR] 1.3; 95% confidence intervals [CI] = 1.1 to 1.7); presented with poor sleep (OR 2.7; 95% CI = 1.5 to 5.0); had abnormal ear (OR 6.5; 95% CI = 2.5 to 17.2), throat (OR 2.2; 95% CI = 1.1 to 4.5) or chest examination (OR 13.6; 95% CI = 5.8 to 32.2); were diagnosed with lower respiratory tract infection (OR 9.5; 95% CI = 3.7 to 25.5), tonsillitis/sore throat (OR 119.3; 95% CI = 28.2 to 504.6), ear infection (OR 26.5; 95% CI = 7.4 to 95.7) or urinary tract infection (OR 12.7; 95% CI = 4.4 to 36.5); or if the responsible clinician perceived the child to be moderately to severely unwell (OR 4.0; 95% CI = 1.4 to 11.4). The area under the receiver operating characteristic curve was 0.9371.


CONCLUSIONS
Respiratory infections were responsible for 74.4% of antibiotic prescriptions. Diagnoses of tonsillitis, sore throat, or ear infection were associated most with antibiotic prescribing. Diagnosis seemed to be more important than abnormal examination findings in predicting antibiotic prescribing, although these were correlated.
Division of Population Medicine.
Kathryn
K
O'Brien
Great Western Hospital, Swindon.
Thomas Wyn
TW
Bellis
South East Wales Trials Unit, Cardiff University, Cardiff.
Mark
M
Kelson
South East Wales Trials Unit, Cardiff University, Cardiff.
Kerenza
K
Hood
Nuffield Department of Primary Care Health Sciences Oxford University, Oxford and Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
Christopher C
CC
Butler
Division of Population Medicine and professor of primary care, School of Medicine;
Adrian
A
Edwards
D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data; D007223:Infant; D007239:Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods; D011446:Prospective Studies; D063189:Symptom Assessment / Q000379:methods / Q000706:statistics & numerical data; D014852:Wales / Q000453:epidemiology
D000900:Anti-Bacterial Agents
acute disease; antibacterial agents; antibiotic prescribing; children; infection; primary care