Parents' Perspective of Antibiotic Usage in Children: A Nationwide Survey in Italy

Parents' expectation of antibiotic prescriptions for respiratory infections in children: a systematic review and meta-analysis

Objectives

Despite most childhood infections being self-limiting, children are among the leading consumers of antibiotics. Little is known about parental expectations of antibiotics for childhood infections. A comprehensive systematic review and meta-analysis was conducted to explore the nature and extent of parental expectations of antibiotic prescriptions for children with respiratory infections.

Design

Systematic review and meta-analysis.

Methods

An extensive literature search using six major scientific databases was conducted for all published articles until 7 December 2022. Primary studies reporting parents' expectations of antibiotics for children with upper respiratory tract infections were included after assessment for quality. Heterogeneity between the studies was assessed using the I² statistic and publication bias was analyzed using funnel plots and Egger regression tests. The primary outcome was a summary estimate of the percentage of parents who expect antibiotics from their physicians when their child presents with an upper respiratory tract infection.

Results

From a total of 4510 studies found in the initial searches, a final pool of 19 eligible studies with 15,664 individuals was included in this meta-analysis. Nine of the 19 studies were from the United States or Saudi Arabia. The pooled prevalence of parental expectations of antibiotics in the population reviewed was 55.78% (95% CI = 44.60-66.41). There was significant heterogeneity between the studies, but funnel plot and meta-regression did not detect any publication bias.

Conclusion

More than half of parents expect antibiotics for their children during consultation for upper respiratory tract infections. Such practices may cause undue side effects among children, contribute to the growing burden of antibiotic resistance, and lead to treatment failure for many common infections in the future. To optimize efforts to tackle antimicrobial resistance, shared decision-making and education emphasizing the proper and judicious use of antibiotics are much needed in pediatric healthcare settings. This can also help to manage parents' expectations when seeking antibiotics for their children. Despite pressure from parents, pediatric healthcare providers should continue to advocate for antibiotic use only when warranted and help improve knowledge and awareness amongst parents.

Registration

The protocol has been registered with PROSPERO (CRD42022364198).

Determinants of antibiotic prescriptions in a large cohort of children discharged from a pediatric emergency department

While there is evidence of high use of wide-spectrum antibiotics in children evaluated in the pediatric emergency departments, determinants of this behavior are still unclear. This study was aimed at defining the demographic, social, clinical, and laboratory factors that affect antibiotic prescriptions in children discharged from the emergency department. We performed a retrospective observational study of children aged younger than 18 years discharged from a pediatric university hospital between Jan. 1, 2015 and Dec. 31, 2020. We determined the proportion and type of antibiotic prescription according to demographic, social, clinical, laboratory, and imaging data, as well as doctor's expertise. Fifty-one thousand six hundred thirty-three children were included, and 13,167 (25.5%) received an antibiotic prescription. Amoxicilline/clavulanate (Am/Cl) was the most prescribed antibiotic (8453, 64.2% of all prescriptions). Factors independently associated with an antibiotic prescription were older age (OR = 1.62 [1.53-1.73] for age 2-5 years, OR = 1.77 [1.64-1.91] for age 6-10 years, OR = 1.36 [1.25-1.49] for age 11-18 years, p < 0.001 for all groups); being evaluated by a physician with > 3 years of pediatric expertise (OR = 1.22 [1.13-1.31], p < 0.001); fever peak higher than 40 °C (OR = 1.37 [1.21-1.54], p < 0.001); abnormal findings on auscultation (OR = 1.95 [1.75-2.17], p < 0.001), CRP values (OR = 1.63 [1.26-2.10] for CRP < 50 mg/L, and OR = 3.78 (2.75-5.21) for CRP ≥ 50 mg/L with respect to CRP not requested; p < 0.01); CXR results whatever positive (OR = 4.47 [3.62-5.52], p < 0.001) or negative (1.82 [1.62-2.04], p < 0.001); being diagnosed with upper respiratory tract infections (OR = 4.27 [4.04-4.51], p < 0.001), lower respiratory tract infections (OR = 5.35 [4.88-5.85]; p < 0.001), and UTI (OR = 9.33 [8.14-10.71], p < 0.001).    Conclusions: Overprescription of antibiotics, including Am/Cl, is relevant in pediatric emergency departments. Factors associated with overprescription are not limited to the clinical characteristics of the treated patients. These findings highlight the need for a new and comprehensive approach to ensure successful antibiotic stewardship initiatives in the emergency departments. What is Known: • Antibiotic resistance is a growing problem in medical practice, including in pediatrics. • Antibiotics are overprescribed in children assessed in the emergency department, but comprehensive and large studies are lacking. What is New: • Factors associated with overprescription are not limited to the clinical characteristics of the patients. • Non-clinical factors such as environmental variables, doctor's expertise, and attitudes to laboratory and radiological examinations affect prescription.

Knowledge, attitudes and practices of parents regarding antibiotic use among children: Differences between urban and rural areas in the Republic of Srpska

Background/Aim: Antibiotic use and resistance represent a growing public health issue, with a specific risk of uncontrolled use of antibiotics in children. The aim of the study was to examine differences in parental knowledge, attitudes and practices about antibiotic use in children between urban and rural areas of the Republic of Srpska. Methods: A cross-sectional study was conducted among 1459 parents of children under 6 years of age, out of which 1201 (82.3 %) lived in urban areas while 258 (17.7 %) lived in rural areas. The research is conducted among parents who brought their children to the selected primary healthcare centres and among parents of children in preschool institutions. Results: The majority of respondents (98.4 %) state that doctors are their main source of information. Only 61.2 % of respondents precisely know which drug is an antibiotic when offered different drugs and respondents from rural areas (54.3 %) more often (p = 0.012) gave more accurate answers when compared to respondents from urban areas (37.3 %). Among parents, 86 % agree with the statement that improper use of antibiotics reduces their effectiveness and leads to bacterial resistance, regardless of groups. More than a half of respondents (52.4 %) do not think that children with flu or common cold symptoms recover faster when they receive antibiotics, significantly more respondents from urban areas (p = 0.001). Respondents from rural areas significantly more often believe that antibiotics can produce harmful effects compared to respondents from urban areas (p = 0.049). Respondents from rural areas significantly more often think that antibiotic use can prevent complications caused by inflammation of the upper respiratory tract (p = 0.006). Parents from rural areas give their children antibiotics without a paediatrician's recommendation significantly more often (4.3 %) compared to respondents from urban areas (0.6 %) (p < 0.001). Conclusion: There are differences in parental knowledge, attitudes and practices regarding antibiotic use and antimicrobial resistance among parents in rural and urban areas. There is need for additional education of parents and for greater engagement of paediatricians in providing guidance and explanations regarding the use of antibiotics.

Evaluation of parental knowledge, attitudes and practices regarding antibiotic use in acute upper respiratory tract infections in children under 18 years of age: a cross-sectional study in Turkey

Background

Upper respiratory tract infections (URTIs) are common in children. Antibiotics still continue to be prescribed although most URTIs are of viral origin. This is inappropriate use and this unnecessary administration contributes or may cause antibiotic resistance. The problem of unnecessary antibiotic use among children is a concern for antibiotic resistance in low- and middle-income developing countries. This study aims to evaluate the knowledge and attitudes of parents of children with upper respiratory tract infections regarding antibiotic use and their antibiotic administration practices in a tertiary care hospital in Turkey.

Methods

Our study is a cross-sectional survey study. It was carried out between 14 December 2020 and 1 April 2021 for parents over 18 years of age with a child under 18 years’ old who applied to the general pediatrics outpatient clinics of Gazi University Faculty of Medicine Hospital Department of Pediatrics.

Results

Five hundred fifty-four parents responded to the questionnaire (93.2% rate of response). A total of 15.7% of parents stated to use antibiotics in any child with fever. 37% of parents believed that antibiotics could cure infections caused by viruses. 6.3% of parents declared that they put pressure on pediatricians to prescribe antibiotics. While 28% of the parents who thought that the use of inappropriate antibiotics would not change the effect and resistance of the treatment, 41% thought that new antibiotics could be developed continuously. 85.6% of the parents stated that they never gave their children non-prescription antibiotics when they had a high fever. 80.9% of them declared that they never used past antibiotics in the presence of a new infection.

Conclusion

According to the results of our study of parents’ lack of knowledge about antibiotics in Turkey, though generally it shows proper attitude and practices. It shows that some of the restrictions imposed by the National Action Plan are partially working. However, it is still necessary to continue to inform parents, pediatricians and pharmacists about the use of antibiotics, and to be more sensitive about the prescribing of antibiotics, and if necessary, sanctions should be imposed by the state in order to prevent unnecessary antibiotic prescriptions.