Appropriateness of antibiotic prescriptions in community-acquired acute pediatric respiratory infections in Spanish emergency rooms

Objective. To describe the variability and appropriateness of antibiotic pr escriptions in community-acquired acute respiratory infections (ARI) during childhood in Spain. Methods. A descriptive, multicenter study of variabili ty in clinical practice was conducted by evaluating a prospective series of pediatric patients attending the emergency rooms of 11 Spanish hospitals a nd diagnosed with community aquired ARL The appropriateness of the antibiot ic prescriptions was assessed by comparing our clinical practice with conse nsus guidelines developed for this study. Results. We collected data from 6 ,249 ARI emergencies studied on 30 separate days. Antibiotics were prescrib ed in 58.7% of the ARI (bronchiolitis, 11.5%; bronchitis, 40.2%; pharyngoto nsillitis, 80.9%; nonspecified ARI, 34.8%; pneumonia, 92.4%; otitis, 93.4%; sinusitis, 92.6%). The most commonly used antibiotics were amoxicillin/cla vulanate (33.2%), amoxicillin (30.2%), cefuroxime axetil (8.5%) and azithro mycin (6%). According to the consensus guidelines developed for this study, therapy was considered to be appropriate in 63.1% of the ARI (first choice , 52.1%; alternative choice, 11.0%) and inappropriate in 36.9%. The percent ages of inappropriate prescription according to ARI groups were: bronchioli tis, 11.5%; bronchitis, 31.5%; pharyngotonsillitis, 54.8%; nonspecified ARI , 34.7%; pneumonia, 13.9%; otitis, 25.6%; and sinusitis, 22.2%. Conclusions. There is excessive use of antibiotics in acute respiratory inf ections that are presumably viral in origin. An important number of ARI of potentially bacterial origin are treated with antibiotics that are not suff iciently efficacious or that have a broader spectrum than necessary.