C. Ochoa et al., Appropriateness of antibiotic prescriptions in community-acquired acute pediatric respiratory infections in Spanish emergency rooms, PEDIAT INF, 20(8), 2001, pp. 751-758
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.