Antimicrobial use in febrile children diagnosed with respiratory tract illness in an emergency department

Background. In an era of increasing antibiotic resistance, the prevalence o f antibiotic usage and associated factors should be ascertained to optimize their use. We set out to determine the prevalence of antibiotic use in feb rile children diagnosed with respiratory tract illnesses at a children's ho spital emergency department; to determine how often viral studies were cond ucted; and to identify patient characteristics associated with antibiotic u se. Methods. We conducted a retrospective study of antibiotic use in febrile ch ildren 3 months to 10 years old presenting with respiratory illnesses durin g two 1-month periods. Patient charts and laboratory tests were reviewed. A ntibiotic use was related to diagnosis by logistic regression. Results. A total of 836 patient visits were selected, Antibiotics were pres cribed for otitis media in 96% of patients, for pneumonia in 100%, for phar yngitis in 66%, for bronchiolitis in 38%, for reactive airway disease in 24 % and for viral or "upper respiratory tract illness" in 14%, For viral illn ess or upper respiratory tract infection, antibiotic use was associated wit h a fever duration of >48 h [odds ratio (OR), 3.2; 95% confidence interval (CI) 1.7, 5.9] and having a chest radiograph performed (OR 2.1; 95% CI 1.02 , 4.37). Patients with pharyngitis who had a throat swab were less likely t o receive an antibiotic (OR 0.08; 95% CI 0.02, 0.4) than those who did not have a swab. In this emergency department antibiotic use for these indicati ons decreased by 11% during the 1997 to 1998 study interval (P < 0.001). Conclusion. Antibiotics were commonly prescribed for pharyngitis, bronchiol itis and reactive airway disease, which are conditions principally caused b y viruses. Addressing reasons why there is a difference between guidelines and antibiotic use in these conditions may be important.