Principles of Judicious Antibiotic Prescribing for Bacterial Upper Respiratory Tract Infections in Pediatrics

Post on November 28, 2013 by André Broussard, D.C.

Pediatrics 2013 Nov 18;[EPub Ahead of Print], AL Hersh, MA Jackson, LA Hicks Consensus and Guidelines · November 28, 2013

TAKE-HOME MESSAGE

Judicious Prescription of Antibiotics for Pediatric UTI

  • This review is focused on appropriate diagnosis and judicious antibiotic use for pediatric patients with UTI.
  • The article provides a practical guide to reducing antibiotic use in this setting.

Commentary By: Bruce Patrick Barrett, MD, PhD

This clinical report, published by the American Academy of Pediatrics, discusses principles of judicious antibiotic use for acute respiratory infection in children.

  • First principle: Accurate diagnosis, focusing on likelihood of bacterial involvement. Only acute otitis media (AOM), group A streptococcal pharyngitis (GAS), and acute bacterial sinusitis (ABS) have been shown to receive any benefit from antibiotics. Common cold, non-streptococcal sore throat, and acute cough illness, sometimes classified as bronchitis, should not be treated with antibiotics.
  • Second principle: Judiciously weigh the likelihood of benefits and harms, both in terms of frequency and severity. Antibiotic-attributable reductions in severity and duration of symptoms in AOM, GAS, and ABS suggested by clinical trials have been modest. Risks of severe bacterial complications, such as meningitis, mastoiditis, and rheumatic heart disease, are extremely low and have not been shown to be affected by antibiotic use. Common side effects of antibiotics include stomach upset, nausea, dizziness, and rash. This report cites work suggesting more than 150,000 clinical visits due to antibiotic-related adverse effects.
  • Third principle: Implement judicious prescribing strategies. Despite complete lack of evidence that antibiotics can work for acute cough illness (bronchitis) in children, this report cites work suggesting that antibiotics are prescribed more than 70% of the time, with more than 2 million pediatric office visit annually. Clearly, current practice is not always so judicious.

Full Story:  http://www.practiceupdate.com/journalscan/6885

Journal Abstract:  http://pediatrics.aappublications.org/content/132/6/1146

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