Antibiotics overprescribed for paediatric URTIs
Despite contemporary research, antibiotics continue to be unnecessarily prescribed for many cases of pediatric upper respiratory tract infections (URTIs), says an expert.
“The commonest URTIs we encounter in the paediatric population are cases of the common cold,” said Associate Professor Anne Goh, senior consultant respirologist at KK Women and Children’s Hospital, Singapore. “We know that the majority are caused by viruses and therefore self-limiting, and yet the greatest use of antibiotics are for URTIs.”
Speaking at the 2017 Betadine® Speaker Council Forum in Kuala Lumpur, Goh cited multiple studies illustrating the issue, among which was an Australian study which found antibiotics prescribed for 21.9% of 1,651 acute respiratory infections, which included 154 infants within the first 2 years of life; as well as a 2017 study from the Netherlands which found antibiotics initiated in 33.5% of 560 pediatric URTI cases, though viral agents were identified in 81.6% of them. [Pediatr Pulmonol 2016;51:1336–1346; BMC Infect Dis 2017;17:62]
In Malaysia itself, a recent analysis of data from the 2014 National Medical Care Survey found that of 2,857 URTI cases recorded among a mixed cohort of children and adults, antibiotics were prescribed in 46.2% of them. [BMC Infect Dis 2016;16:208]
Goh reiterated that many physicians primarily turn to antibiotics for URTIs either in a belief that antibiotics hasten recovery; concerns over potential complications or progression to the lower respiratory tract; or perceived pressure from the parents involved.
“Very often, especially with very young children and no effective treatment otherwise for (viral URTIs), they are stuck in terms of what they can give,” said Goh. “The easiest option may seem to be an antibiotic.”
While antibiotics are indicated for some URTIs with bacterial causes such as group A Streptococcal infections, Goh advised that such infections should be verified via throat swab cultures or rapid antigen tests before antibiotic prescription.
“Mucopurulent nasal discharge is not an indication for antibiotics,” said Goh, highlighting a 1998 quantitative review of 1,699 children between 0 to 12 years, surveyed across 6 randomized placebo-controlled clinical trials, which concluded that clinical outcomes for pediatric URTIs were not improved by various common antibiotics. (RR 1.01, 95% CI 0.9–1.13) [Arch Dis Child 1998;79:225–230]
In addition to this, she referred to a more recent review of 1,314 children aged 2 to 59 months across four trials, which not only found insufficient evidence to support the use of antibiotics in preventing bacterial complications from URTIs, but concluded that supportive care (eg, breastfeeding, clearing of the nose and paracetamol for fever control) provided comparative benefits to antibiotic prescriptions. (RR 1.05, 95% CI 0.74 – 1.49) [Cochrane Database Syst Rev 2016;29:2]
“[From the studies] we can conclude antibiotics do not alter clinical course of URTIs, reduce complication rates, reduce progression of pneumonia, or—even in high risk children—reduce pneumonia, exacerbations, hospital admission or mortality,” noted Goh.
Ed: The speaker disclaimer states she was presenting independent material and uninfluenced by the workshop‘s sponsor.