"Why do paediatricians prescribe antibiotics? Results of an Italian regional project"

To investigate determinants of antibiotic prescription in paediatric care, as a first step of a multilevel intervention to improve prescribing for upper respiratory tract infections (URTIs) in a northern Italian region with high antibiotic prescription rate.

Methods: A two-step survey on knowledge, attitudes and practice toward URTIs was performed involving all family and hospital paediatricians of Emilia-Romagna and a sample of parents.

Results: The response rate was 84%. More than 50% of paediatricians affirm to not adopt a "wait and see strategy"in acute otitis.

Diagnostic uncertainty was perceived as one critical determinants of antibiotic prescription, but rapid antigen detecting tests, helpful to reduce uncertainty, were rarely used in clinical practice. Parental expectation of antibiotics was not perceived as a crucial determinant of prescription while direct observation showed that it actually was (OR=12.8; 95% CI 10.4 - 15.8).

Most parents lacked knowledge of URTIs and antibiotics, and sought medical care for trivial infections.

Conclusion: A wide gap between perceived and real determinants of antibiotic prescription exists. This can promote antibiotic overuse.

Inadequate parental knowledge can also induce inappropriate prescription. The value of this study is that it simultaneously explored all determinants of antimicrobial prescribing in an entire region involving both professionals and parents.

Author: Maria Luisa MoroMassimiliano MarchiCarlo GagliottiSimona Di MarioDavide ResiProgetto Bambini e Antibiotici Regional Group [ProBA] Group
Credits/Source: BMC Pediatrics 2009, 9:69

Published on: 2009-11-06

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