Antibiotic treatments for children ages 0-23 months in a northern Italy region: a cohort study.
ABSTRACT This study aims to describe the pattern of antibiotic treatments in the community for children ages 0-23 months in Emilia-Romagna (a northern Italy region) pointing out possible changes of prescribed agents when first treatments in the life of each children are compared to successive ones.
The Regional Drug Prescription and the Resident Population databases were used as data sources to study the cohort of children born between January 1 and December 31, 2000 and resident in Emilia-Romagna.
The cumulative incidences of children with at least one treatment were 22%, 55% and 82% at 6, 12 and 24 months of age, respectively. Broad spectrum penicillins were the most prescribed antibiotic class for children at their first treatment while cephalosporins were the most prescribed class for successive treatments and when pooling all treatments.
Cephalosporins and other second line antibiotics are frequently prescribed to 0 to 23-month-old residents in Emilia-Romagna even when only first treatments are considered; further research is needed to quantify inappropriateness of antibiotic prescription.
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ABSTRACT: The impact of clinical decision support systems (CDSS) on antimicrobial prescribing in ambulatory settings has not previously been evaluated. To measure the added value of CDSS when coupled with a community intervention to reduce inappropriate prescribing of antimicrobial drugs for acute respiratory tract infections. Cluster randomized trial that included 407,460 inhabitants and 334 primary care clinicians in 12 rural communities in Utah and Idaho (6 with 1 shared characteristic and 6 with another), and a third group of 6 communities that served as nonstudy controls. The preintervention period was January to December 2001 and the postintervention period was January 2002 to September 2003. Acute respiratory tract infection diagnoses were classified into groups based on indication for antimicrobial use. Multilevel regression methods were applied to account for the clustered design. Six communities received a community intervention alone and 6 communities received community intervention plus CDSS that were targeted toward primary care clinicians. The CDSS comprised decision support tools on paper and a handheld computer to guide diagnosis and management of acute respiratory tract infection. Community-wide antimicrobial usage was assessed using retail pharmacy data. Diagnosis-specific antimicrobial use was compared by chart review. Within CDSS communities, 71% of primary care clinicians participated in the use of CDSS. The prescribing rate decreased from 84.1 to 75.3 per 100 person-years in the CDSS arm vs 84.3 to 85.2 in community intervention alone, and remained stable in the other communities (P = .03). A total of 13,081 acute respiratory tract infection visits were abstracted. The relative decrease in antimicrobial prescribing for visits in the antibiotics "never-indicated" category during the post-intervention period was 32% in CDSS communities and 5% in community intervention-alone communities (P = .03). Use of macrolides decreased significantly in CDSS communities but not in community intervention-alone communities. CDSS implemented in rural primary care settings reduced overall antimicrobial use and improved appropriateness of antimicrobial selection for acute respiratory tract infections. ClinicalTrials.gov Identifier: NCT00235703.JAMA The Journal of the American Medical Association 12/2005; 294(18):2305-14. · 29.98 Impact Factor
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ABSTRACT: Providers' interest in satisfying parents may provide an impetus for unnecessary antibiotic use in children. To determine (1) whether receipt of antibiotics at a visit for cough and cold symptoms was associated with increased satisfaction and (2) whether nonreceipt of antibiotics at an initial visit but subsequent receipt of antibiotics in the course of the same illness episode was associated with decreased satisfaction. Prospective cohort study of patients 2-10 years of age presenting to a university-affiliated pediatric clinic with cough and cold symptoms. Parents were enrolled at the index visit and then followed up by phone at least 7 days later (mean time to follow-up, 14.9 days). Satisfaction with the index visit on a 10 point scale was the primary outcome. The primary predictors were whether antibiotics were prescribed at the index visit and, if not, whether they were prescribed since that visit. Linear and median regression were used to adjust for income, child age, parental race and individual provider. A total of 539 parents were enrolled in the study, and 378 (70%) completed follow-up interviews. The mean age of participating children was 4.67 years (SD 2.16). Overall 47% of patients received antibiotics at the index visit, and 8% of those that did not reported receiving them between the index visit and the follow-up assessment. In the regression model, receiving antibiotics at the index visit trended toward being associated with higher satisfactions scores (0.28; P = 0.08). Among those who did not receive antibiotics initially, receiving them subsequently was associated with significantly lower median satisfaction score for the index visit (-3.0; P < 0.01). Receiving antibiotics after an initial visit for cough and cold symptoms at which antibiotics were not prescribed is associated with decreased satisfaction. Use of contingency prescriptions may be an important intervention.The Pediatric Infectious Disease Journal 10/2005; 24(9):774-7. · 3.57 Impact Factor
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ABSTRACT: The aim was to examine the impact of socioeconomic factors on the use of systemic antibiotics during the first 2 years of life. This was a population-based cohort study of 5024 Danish children born in 1997. The study was conducted by linking records drawn from public administrative registries. The main predictor variables were mother's education level, household income and cohabitation status. The outcome was the number of antibiotic courses (0, 1-5, > or =6) during the first 2 years of life. A total of 3273 children (65.1%) received 1-5 antibiotic courses, and 337 (6.7%) received > or =6 courses of antibiotics during the first 2 years of life. The risk of receiving > or =6 courses of antibiotics was increased in children of mothers with a low educational level (< or =10 years) compared with vocational education [OR 1.3 (95% CI 1.0-1.7)]. Children of mothers with a higher education >4 years had a reduced risk of receiving > or =6 courses [OR 0.3 (95% CI 0.1-0.7)]. Children from high-income families had a reduced risk (not statistically significant) of receiving antibiotics, compared with children from middle-income families [1-5 and > or =6 courses: adjusted OR 0.6 (95% CI 0.3-1.2)]. Children of single mothers had an increased risk of receiving antibiotics, particularly if the child did not attend day care. Socioeconomic factors have some impact on antibiotic prescription in young children. Children of mothers with only basic schooling were at highest risk of receiving multiple prescriptions, whereas children of mothers with a high education, and/or high household income, had the lowest risk.Journal of Antimicrobial Chemotherapy 03/2003; 51(3):683-9. · 5.34 Impact Factor