title: Recent trends in prescribing antibiotics for acute tonsillitis in pediatric ambulatory care in Taiwan, 2000-2009: A nationwide population-based study.
abstract: OBJECTIVE
  Acute tonsillitis is the leading diagnosis in pediatric ambulatory care, and group A beta-hemolytic streptococcus is the main reason for antibiotic prescriptions in patients with acute tonsillitis. The aim of this study was to analyze trends in prescribing antibiotics and to investigate the prescription patterns for acute tonsillitis in pediatric ambulatory care in Taiwan from 2000 to 2009.
  
  
  METHODS
  Data on children younger than 18 years with a primary diagnosis of acute tonsillitis were retrieved from the National Health Insurance Research Database of Taiwan from 2000 to 2009. Concomitant bacterial infections were excluded. Sex, age, seasonality, location, level of medical institution, and physician specialty were analyzed. Annual and monthly changes in antibiotic prescriptions and classification were also evaluated.
  
  
  RESULTS
  A total of 40,775 cases were enrolled, with an overall antibiotic prescription rate of 16.8%. There was a remarkable decline in the antibiotic prescription rates for tonsillitis from 28.4% in 2000 to 10.9% in 2009. Factors associated with a higher prescription rate included older age, visits from eastern Taiwan, medical centers, and nonpediatrician physicians. Otolaryngologists had higher antibiotic prescription rate, whereas pediatricians had the lowest (21.9% vs. 11.6%). The rates of obtaining throat cultures were low although the culture performing rate in the medical centers was significantly higher (12.3%, p < 0.001).
  
  
  CONCLUSIONS
  From 2000 to 2009, there was a remarkable decline in the antibiotic prescription rates for tonsillitis. Further studies to evaluate diagnostic tools such as rapid antigen detection tests or throat cultures to decrease antibiotic prescriptions are warranted.
authors.affiliation: Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Lo-Yi
authors.initials: LY
authors.lastname: Chang
authors.affiliation: Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chou-Cheng
authors.initials: CC
authors.lastname: Lai
authors.affiliation: Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chun-Jen
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Cho
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yu-Cheng
authors.initials: YC
authors.lastname: Luo
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Mei-Jy
authors.initials: MJ
authors.lastname: Jeng
authors.affiliation: Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan. Electronic address: kgwu@vghtpe.gov.tw.
authors.forename: Keh-Gong
authors.initials: KG
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods* / Q000639:trends; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000639:trends*; D013624:Taiwan; D014069:Tonsillitis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: National Health Insurance Research Database; Taiwan; acute tonsillitis; ambulatory visits; antibiotics; children