Clinical predictors of antibiotic prescribing for acutely ill children in primary care: an observational study

O'Brien, Kathryn, Bellis, Thomas Wyn, Kelson, Mark ORCID: https://orcid.org/0000-0001-7744-3780, Hood, Kerenza ORCID: https://orcid.org/0000-0002-5268-8631, Butler, Christopher ORCID: https://orcid.org/0000-0002-0102-3453 and Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446 2015. Clinical predictors of antibiotic prescribing for acutely ill children in primary care: an observational study. British Journal of General Practice 65 (638) , e585-e592. 10.3399/bjgp15X686497

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Abstract

Background: Antibiotic overuse and inappropriate prescribing drive antibiotic resistance. Children account for a high proportion of antibiotics prescribed in primary care. Aim: To determine the predictors of antibiotic prescription in young children presenting to UK general practices with acute illness. Design and setting: Prospective observational study in general practices in Wales. Method: 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. Conclusion: 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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine Systems Immunity Research Institute (SIURI)
Subjects:	R Medicine > R Medicine (General)
Publisher:	Royal College of General Practitioners
ISSN:	0960-1643
Date of First Compliant Deposit:	20 November 2017
Date of Acceptance:	12 May 2015
Last Modified:	08 Nov 2024 06:30
URI:	https://orca.cardiff.ac.uk/id/eprint/79165

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