Paediatricians Approach to Prescribing of Systemic Antimicrobials in Outpatient Children with Upper Respiratory Tract and ENT Infections: Data from Multicenter Survey

Clinical Microbiology and Antimicrobial Chemotherapy. 2016; 18(1):20-32

Type
Journal article

Objective.

Objectives. The study aimed to assess paediatricians knowledge of etiology and approach to systemic antimicrobials (АМ) use in outpatient children with acute respiratory tract infections.

Materials and Methods.

A questionnaire survey of primary care paediatricians from 17 cities of Russian Federation was performed in 2011–2013 in compliance with the unified methodology.

Results.

A total of 701 paediatricians (mean age 46,3±10,7, 61,5% with work experience >15 years) took part in the survey. H. influenzae (26,4%), S. aureus (23,8%), S. pneumoniae (22,3%) were named among the most common pathogens of acute otitis media (AOM), while S. pyogenes (50,7%) и S. aureus (26,4%) — of acute bacterial tonsillopharyngitis (ABT). Altogether 71% of respondents reported otoscopy to be a part of diagnostic process in children with AOM. The vast majority of respondents declared they didn’t generally prescribe sAB for common cold, 89,3% of them experienced direct parents demand for AM use in children. High clinical efficacy (87,4%), possibility of oral administration (64,6%) and safety issues (62,6%) were the most commonly mentioned as the criteria of AM choice. In the vast majority of cases either penicillins (mainly amoxicillin/clavulanate) or macrolides (mainly azithromycin) were chosen for empiric therapy of outpatient children with AOM, ABT and acute rhinosinusitis. Post-graduate courses (81,3%), pharmaceutical sales representatives (80,3%), medical conferences (74,9%) were named among the main sources of information about AM by the respondents.

Conclusions.

Overestimated etiological role of S. aureus, possible negative influence of pharmaceutical companies and common parental demand for AM prescription in children in primary care are the main problems revealed. Inappropriatly high rate of inhibitor-protected penicillins choice in case of acute uncomlicated infections requires further educational actions.

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