Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: a systematic review and meta-analysis

Talley Andrews, Matthew Thompson, David I Buckley, Carl Heneghan, Rick Deyo, Niamh Redmond, Patricia J Lucas, Peter S Blair, Alastair D Hay, Talley Andrews, Matthew Thompson, David I Buckley, Carl Heneghan, Rick Deyo, Niamh Redmond, Patricia J Lucas, Peter S Blair, Alastair D Hay

Abstract

Background: Respiratory tract infections (RTIs) are common in children and generally self-limiting, yet often result in consultations to primary care. Frequent consultations divert resources from care for potentially more serious conditions and increase the opportunity for antibiotic overuse. Overuse of antibiotics is associated with adverse effects and antimicrobial resistance, and has been shown to influence how patients seek care in ensuing illness episodes.

Methodology/principal findings: We conducted a systematic review and meta-analysis to assess the effectiveness of interventions directed towards parents or caregivers which were designed to influence consulting and antibiotic use for respiratory tract infections (RTIs) in children in primary care. Main outcomes were parental consulting rate, parental knowledge, and proportion of children subsequently consuming antibiotics. Of 5,714 references, 23 studies (representing 20 interventions) met inclusion criteria. Materials designed to engage children in addition to parents were effective in modifying parental knowledge and behaviour, resulting in reductions in consulting rates ranging from 13 to 40%. Providing parents with delayed prescriptions significantly decreased reported antibiotic use (Risk Ratio (RR) 0.46 (0.40, 0.54); moreover, a delayed or no prescribing approach did not diminish parental satisfaction.

Conclusions: IN ORDER TO BE MOST EFFECTIVE, INTERVENTIONS TO INFLUENCE PARENTAL CONSULTING AND ANTIBIOTIC USE SHOULD: engage children, occur prior to an illness episode, employ delayed prescribing, and provide guidance on specific symptoms. These results support the wider implementation of interventions to reduce inappropriate antibiotic use in children.

Conflict of interest statement

Competing Interests: MT and CH receive financial compensation for conducting evidence-based training, workshops, and developing an iPhone application with the CEBMi and the BMJ Publishing Group. MT was reimbursed for travel and accommodation to give a plenary talk at ESPID meetings in 2010 and 2011 by the European Society for Pediatric Infectious Disease and has received financial compensation to teach evidence-based medicine courses by Isis Consulting. Two reviewers (MT and TA) were reimbursed for travel to meetings to discuss work leading to this review (NIHR RP-PG-0608-10018). RD received honoraria for attending board meetings of the Foundation for Informed Medical Decision Making and honoraria for writing on back pain topics for UpToDate. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

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Source: PubMed

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