Review of antibiotic use in pediatric respiratory infections (only available in French)

 
This study was born out of a common desire between the Collège des médecins du Québec and the Conseil du médicament to document antibiotic utilization in pediatrics in Québec. The emergence of antibiotic-resistant bacterial strains is worrisome, and the increased frequency of antibiotic prescriptions is a likely contributor to the development of antibiotic resistance. Many researchers have reported the frequent and often inappropriate use of antibiotics in the treatment of respiratory tract infections (RTI) in young children. The main objective of this study was to evaluate antibiotic usage in the treatment of common RTIs in children. Usage was measured against seven optimal usage criteria that had been determined according to established guidelines. The criteria evaluated the choice of the prescribed antibiotic, the antibiotic dosage, the length of treatment, the use of antibiotics to treat viral infections, and the administration of a diagnostic test prior to antibiotic treatment in cases of uncomplicated pharyngitis/tonsillitis.

A retrospective review of medication use was performed in children aged three months to six years who had been to see a doctor for an RTI without an appointment. Data was collected from medical files showing consultations between January 1 and March 31, 2004, mainly in six regions of Québec.

There were 11,046 children sampled, 4,025 of whom were covered by the public prescription drug insurance plan and 7,021 of whom were covered by a private plan. Overall, 55% of children were given an antibiotic prescription following the consultation for an RTI. In cases of otitis, pharyngitis/tonsillitis or rhinosinusitis, 49% of children were given an antibiotic other than amoxicillin (or penicillin V) as first-line treatment. When antibiotics were prescribed as second-line treatment following the recommended first-line treatment, the choice of antibiotic was in line with recommendations in 19% of cases. When amoxicillin was prescribed to treat otitis or rhinosinusitis, the prescribed dose followed recommendations in over 75% of cases. Amoxicillin prescriptions were most often for standard doses. The length of treatment with prescribed antibiotics was in line with recommendations in 95% of cases.

When seen for uncomplicated viral infections, 87% of children were not prescribed antibiotics. However, antibiotic prescription was high in uncomplicated cases of acute bronchitis and rhinosinusitis. When antibiotics were prescribed for pharyngitis/tonsillitis, a diagnostic test was performed beforehand in 39% of cases.

The results of this study are encouraging, as they show that antibiotic use to treat viral infections in Québec has decreased. However, antibiotics are not always prescribed according to recommendations. This is particularly true for the choice of the antibiotic used as first- or second-line treatment, as well as for antibiotic use to treat uncomplicated cases of rhinosinusitis and acute bronchitis.