RT Journal Article
SR Electronic
T1 Interventions to reduce childhood antibiotic prescribing for upper respiratory infections: systematic review and meta-analysis
JF Journal of Epidemiology and Community Health
JO J Epidemiol Community Health
FD BMJ Publishing Group Ltd
SP 1162
OP 1170
DO 10.1136/jech-2015-206543
VO 70
IS 12
A1 Hu, Yanhong
A1 Walley, John
A1 Chou, Roger
A1 Tucker, Joseph D
A1 Harwell, Joseph I
A1 Wu, Xinyin
A1 Yin, Jia
A1 Zou, Guanyang
A1 Wei, Xiaolin
YR 2016
UL http://jech.bmj.com/content/70/12/1162.abstract
AB Background Antibiotics are overprescribed for children with upper respiratory infections (URIs), leading to unnecessary expenditures, adverse events and antibiotic resistance. This study assesses whether interventions antibiotic prescription rates (APR) for childhood URIs can be reduced and what factors impact intervention effectiveness.Methods MEDLINE, Embase, Google Scholar, Web of Science, Global Health, WHO website, United States CDC website and The Cochrane Central Register of Controlled Trials (CENTRAL) were searched by December 2015. Cluster or individual-patient randomised controlled trials (RCTs) and non-RCTs that examined interventions to change APR for children with URIs were selected for meta-analysis. Educational interventions for clinicians and/or parents were compared with usual care.Results Of 6074 studies identified, 13 were included. All were conducted in high-income countries. Interventions were associated with lower APR versus usual care (OR 0.63 (95% CI 0.50 to 0.81, p<0.001). A patient–clinician communication approach was the most effective type of intervention, with a pooled OR 0.41 (95% CI 0.20 to 0.83; p<0.001) for clinicians and 0.26 (95% CI 0.08 to 0.91; p=0.04) for parents. Interventions that targeted clinicians and parents were significant, with a pooled OR of 0.52 (95% CI 0.35 to 0.78; p=0.002). Insignificant effects were observed for targeting clinicians and parents alone, with a pooled OR of 0.88 (95% CI 0.67 to 1.16; p=0.37) and 0.50 (95% CI 0.10 to 2.51, p=0.40), respectively.Conclusions Educational interventions are effective in reducing antibiotic prescribing for childhood URIs. Interventions targeting clinicians and parents are more effective than those for either group alone. The most effective interventions address patient–clinician communication. Studies in low-income to middle-income countries are needed.