TY - JOUR
T1 - Interventions to reduce childhood antibiotic prescribing for upper respiratory infections
T2 - Systematic review and meta-analysis
AU - Hu, Yanhong
AU - Walley, John
AU - Chou, Roger
AU - Tucker, Joseph D.
AU - Harwell, Joseph I.
AU - Wu, Xinyin
AU - Yin, Jia
AU - Zou, Guanyang
AU - Wei, Xiaolin
N1 - Funding Information:
The authors thank Yiwen Huang, the former research assistant, from COMDIS-HSD, Nuffield Centre for International Health Shenzhen office for the contribution to literature review and earlier version of drafting, Professor Robbie Foy from the Leeds Institute of Health Science, University of Leeds and Dr Rebecca King from Nuffield Centre for International Health and Development, University of Leeds for their comments and reviews of this manuscript. This work was supported by Medical Research Council, Global Health Trials developmental grant-funding reference number: MR/M022161/1.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - 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.
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.
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U2 - 10.1136/jech-2015-206543
DO - 10.1136/jech-2015-206543
M3 - Article
AN - SCOPUS:84977592601
SN - 0143-005X
VL - 70
SP - 1162
EP - 1170
JO - Journal of Epidemiology and Community Health
JF - Journal of Epidemiology and Community Health
IS - 12
ER -