title: Factors predicting antibiotic prescription and referral to hospital for children with respiratory symptoms: secondary analysis of a randomised controlled study at out-of-hours services in primary care.
abstract: Acute respiratory infections and fever among children are highly prevalent in primary care. It is challenging to distinguish between viral and bacterial infections. Norway has a relatively low prescription rate of antibiotics, but it is still regarded as too high as the antimicrobial resistance is increasing. The aim of the study was to identify predictors for prescribing antibiotics or referral to hospital among children.
  
  
  
  Secondary analysis of a randomised controlled study.
  
  
  
  4 out-of-hours services and 1 paediatric emergency clinic in Norwegian primary care.
  
  
  
  401 children aged 0-6 years with respiratory symptoms and/or fever visiting the out-of-hours services.
  
  
  
  2 main outcome variables were registered: antibiotic prescription and referral to hospital.
  
  
  
  The total prescription rate of antibiotics was 23%, phenoxymethylpenicillin was used in 67% of the cases. Findings on ear examination (OR 4.62; 95% CI 2.35 to 9.10), parents' assessment that the child has a bacterial infection (OR 2.45; 95% CI 1.17 to 5.13) and a C reactive protein (CRP) value >20 mg/L (OR 3.57; 95% CI 1.43 to 8.83) were significantly associated with prescription of antibiotics. Vomiting in the past 24 hours was negatively associated with prescription (OR 0.26; 95% CI 0.13 to 0.53). The main predictors significantly associated with referral to hospital were respiratory rate (OR 1.07; 95% CI 1.03 to 1.12), oxygen saturation <95% (OR 3.39; 95% CI 1.02 to 11.23), signs on auscultation (OR 5.57; 95% CI 1.96 to 15.84) and the parents' assessment before the consultation that the child needs hospitalisation (OR 414; 95% CI 26 to 6624).
  
  
  
  CRP values >20 mg/L, findings on ear examination, use of paracetamol and no vomiting in the past 24 hours were significantly associated with antibiotic prescription. Affected respiration was a predictor for referral to hospital. The parents' assessment was also significantly associated with the outcomes.
  
  
  
  NCT02496559; Results.
authors.affiliation: National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Ingrid Keilegavlen
authors.initials: IK
authors.lastname: Rebnord
authors.affiliation: National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway.
authors.forename: Hogne
authors.initials: H
authors.lastname: Sandvik
authors.affiliation: Haukeland University Hospital, Bergen, Norway.
authors.forename: Anders Batman
authors.initials: AB
authors.lastname: Mjelle
authors.affiliation: National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Steinar
authors.initials: S
authors.lastname: Hunskaar
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006701:Home Nursing / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009664:Norway; D010290:Parents; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012120:Respiration Disorders / Q000188:drug therapy / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein