» Articles » PMID: 31420054

Antibiotic Prescriptions in Acute Otitis Media and Pharyngitis in Italian Pediatric Outpatients

Overview
Journal Ital J Pediatr
Publisher Biomed Central
Specialty Pediatrics
Date 2019 Aug 18
PMID 31420054
Citations 20
Authors
Affiliations
Soon will be listed here.
Abstract

Background: Acute otitis media (AOM) and pharyngitis are very common infections in children and adolescents. Italy is one of the European countries with the highest rate of antibiotic prescriptions. The aim of this study is to describe first-line treatment approaches for AOM and pharyngitis in primary care settings in Italy over six years, including the prevalence of 'wait and see' for AOM, where prescription of antibiotics is delayed 48 h from presentation, and differences in prescribing for pharyngitis when diagnostic tests are used.

Methods: The study is a secondary data analysis using Pedianet, a database including data at outpatient level from children aged 0-14 in Italy. Prescriptions per antibiotic group, per age group and per calendar year were described as percentages. "Wait and see" approach rate was described for AOM and pharyngitis prescriptions were further grouped according to the diagnostic test performed and test results.

Results: We identified 120,338 children followed by 125 family pediatricians between January 2010 and December 2015 for a total of 923,780 person-years of follow-up. Among them 30,394 (mean age 44 months) had at least one AOM diagnosis (n = 54,943) and 52,341 (mean age 5 years) had at least one pharyngitis diagnosis (n = 126,098). 82.5% of AOM diagnoses were treated with an antibiotic within 48 h (mainly amoxicillin and amoxicillin/clavulanate) and the "wait and see" approach was adopted only in 17.5% of cases. The trend over time shows an increase in broad spectrum antibiotic prescriptions in the last year (2015). 79,620 (63%) cases of pharyngitis were treated and among GABHS pharyngitis confirmed by rapid test 56% were treated with amoxicillin. The ones not test confirmed were treated mainly with broad spectrum antibiotics.

Conclusions: Despite guidance to use the 'wait and see' approach in the age group analyzed, this strategy is not often used for AOM, as previously noted in other studies in hospital settings. Broad-spectrum antibiotic prescription was more frequent when pharyngitis was not confirmed by rapid test, in keeping with evidence from other studies that diagnostic uncertainty leads to overuse of antibiotics.

Citing Articles

Impact of a multifaceted antibiotic stewardship programme in a paediatric acute care unit over 8 years.

Brigadoi G, Gres E, Barbieri E, Liberati C, Rossin S, Chiusaroli L JAC Antimicrob Resist. 2024; 6(6):dlae181.

PMID: 39507942 PMC: 11538966. DOI: 10.1093/jacamr/dlae181.


Treatment of acute pharyngitis in children: an Italian intersociety consensus (SIPPS-SIP-SITIP-FIMP-SIAIP-SIMRI-FIMMG).

Chiappini E, Simeone G, Bergamini M, Pellegrino R, Guarino A, Staiano A Ital J Pediatr. 2024; 50(1):235.

PMID: 39501298 PMC: 11539554. DOI: 10.1186/s13052-024-01789-5.


Appropriateness of antibiotic prescribing in paediatrics: retrospective controlled study assessing a multifaceted intervention in Northern Italy in a 7-year period.

Corsini R, Manzotti R, Zini A, Mezzadri S, Massari M, Formoso G BMJ Paediatr Open. 2024; 8(1).

PMID: 39317655 PMC: 11423717. DOI: 10.1136/bmjpo-2024-002858.


Group A Streptococcus infections in children and adolescents in the post-COVID-19 era: a regional Italian survey.

Cinicola B, Sani I, Pulvirenti F, Capponi M, Leone F, Spalice A Ital J Pediatr. 2024; 50(1):177.

PMID: 39285296 PMC: 11407006. DOI: 10.1186/s13052-024-01750-6.


Evaluating empiric antibiotic prescribing for hospitalized children in Mozambique through the introduction of a quarterly syndromic antibiogram: An implementation science protocol.

Kenga D, Sacarlal J, Sidat M, Amorim G, Myers H, Chicamba V PLoS One. 2024; 19(8):e0306511.

PMID: 39121076 PMC: 11315278. DOI: 10.1371/journal.pone.0306511.


References
1.
Pichichero M . Understanding antibiotic overuse for respiratory tract infections in children. Pediatrics. 1999; 104(6):1384-8. DOI: 10.1542/peds.104.6.1384. View

2.
Little P, Gould C, Williamson I, Moore M, Warner G, Dunleavey J . Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ. 2001; 322(7282):336-42. PMC: 26576. DOI: 10.1136/bmj.322.7282.336. View

3.
van der Meer J, Gyssens I . Quality of antimicrobial drug prescription in hospital. Clin Microbiol Infect. 2002; 7 Suppl 6:12-5. DOI: 10.1046/j.1469-0691.2001.00079.x. View

4.
E Pichichero M . Dynamics of antibiotic prescribing for children. JAMA. 2002; 287(23):3133-5. DOI: 10.1001/jama.287.23.3133. View

5.
Giaquinto C, Sturkenboom M, Mannino S, Arpinelli F, Nicolosi A, Cantarutti L . [Epidemiology and outcomes of varicella in Italy: results of a prospective study of children (0-14 years old) followed up by pediatricians (Pedianet study)]. Ann Ig. 2002; 14(4 Suppl 6):21-7. View