EVALUATION OF PARENT PRESSURE ON PHYSICIA NS FOR THE PRESCRIPTION OF ANTIBIOTICS IN CHILDRENS MILD COMMUNITY-ACQUIRED ENT INFECTIOUS (NASOPHARYNGITIS, CONGESTIVE OTITIS-MEDIA)

Nasopharyngitis and congestive otitis media are mainly due to viral in fections. However, nasopharyngitis represents the first cause of antib iotic prescription for children in France, while no antibiotics is reg istered for this indication. The aim of the present study was to evalu ate the impact of parent pressure on physicians for antibiotic prescri ption. Two questionnaires were written out: one for parents, published in ''Parents Magazine'', and one physicians, published in ''Le Quotid ien du Medecin''. 31 % of parents expected an antibiotic prescription for a common cold with fever. On refusal from the physician, only 5 % of parents admitted using direct pressure on the physician to obtain a ntibiotherapy, or consulting another physician. Physicians feel indire ct pressure from parents since 33 % of them prescribed antibiotics aft er insisting parent demand. The main criteria leading to antibiotherap y were: the purulent aspect of rhinorrhea (77 %), fever lasting more t han 3 days (72 %), the aspect of the tympanic membrane (65,5 %), and r ecurrent ENT infections (65 %). This massively prescribed antibiothera py is in fact often ineffective, since it is not active against viruse s responsible for nasopharyngitis and congestive otitis media. It lead s to economic and ecological problems. Because of the dramatic emergen ce of multi-drug resistant bacteria in the nasopharyngeal flora, antib iotics given to prevent a small proportion of purulent otitis media, a re less and less effective. Better information of parents and a full a wareness of physicians about the consequences of a large prescription of antibiotics should lead to better indications for the treatment of ENT infections in children.