Outcomes after judicious antibiotic use for respiratory tract infections seen in a private pediatric practice

Background. Most respiratory tract infections (RTIs) in children have a vir al cause, they resolve on their own, and antibiotics need not be prescribed . Objective. We sought to provide evidence that judicious antibiotic use can be accomplished in private pediatric practice without observing an increase in return office visits or in the rate of bacterial infections that may fo llow. Study Design. This was a prospective 12-month study from July 1, 1996 throu gh June 30, 1997. On the same 1 day each week, a representative convenience sample of acute respiratory tract illness patients was enrolled, and labor atory studies performed as appropriate, including viral cultures on all. Ch ildren were then followed for 30 days to ascertain the outcomes of not pres cribing antibiotics except when specific bacterial infections were present at the initial visit. Results. Three hundred eighty-three children were enrolled; 293 (77%) did n ot receive antibiotics at the enrollment visit. Ninety children (23%) recei ved antibiotics based on a diagnosis of acute otitis media (n = 53), acute streptococcal tonsillopharyngitis (n = 18), or other presumed or documented bacterial infections (n = 19). An unscheduled return visit related to the initial visit occurred for 86 (29%) of the 293 children not receiving antib iotics initially and in 40 (44%) of 90 children receiving antibiotics initi ally. Eighty-seven children (23%) had positive viral culture results. The m ost frequently isolated viruses were adenovirus, enterovirus, parainfluenza e virus, and influenza virus. Conclusion. Children with RTIs without a concomitant presumed or proven bac terial infection do not require antibiotics. In this busy office practice, >75% of the children presenting with an RTI did not have a presumed or prov en bacterial infection. These children did not have a higher rate of return office visits or an increase in bacterial infections. This reinforces the judicious use of antibiotics in managing children with RTIs.