 |
|
Antibiotic Treatment of Children With Sore Throat
Jeffrey A. Linder, MD, MPH;
David W. Bates, MD, MSc;
Grace M. Lee, MD, MPH;
Jonathan A. Finkelstein, MD, MPH
JAMA. 2005;294:2315-2322.
Context Of children with sore throat, 15% to 36% have pharyngitis caused by group A  -hemolytic streptococci (GABHS). Performance of a GABHS test prior to antibiotic prescribing is recommended for children with sore throat. Penicillin, amoxicillin, erythromycin, and first-generation cephalosporins are the recommended antibiotics for treatment of sore throat due to GABHS.
Objectives To measure rates of antibiotic prescribing and GABHS testing and to evaluate the association between testing and antibiotic treatment for children with sore throat.
Design, Setting, and Participants Analysis of visits by children aged 3 to 17 years with sore throat to office-based physicians, hospital outpatient departments, and emergency departments in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1995 to 2003 (N = 4158) and of a subset of visits with GABHS testing data (n = 2797).
Main Outcome Measures National rates of antibiotic prescribing, prescribing of antibiotics recommended and not recommended for GABHS, and GABHS testing.
Results Physicians prescribed antibiotics in 53% (95% confidence interval [CI], 49%-56%) of an estimated 7.3 million annual visits for sore throat and nonrecommended antibiotics to 27% (95% CI, 24%-31%) of children who received an antibiotic. Antibiotic prescribing decreased from 66% of visits in 1995 to 54% of visits in 2003 (P = .01 for trend). This decrease was attributable to a decrease in the prescribing of recommended antibiotics (49% to 38%; P = .002). Physicians performed a GABHS test in 53% (95% CI, 48%-57%) of visits and in 51% (95% CI, 45%-57%) of visits at which an antibiotic was prescribed. GABHS testing was not associated with a lower antibiotic prescribing rate overall (48% tested vs 51% not tested; P = .40), but testing was associated with a lower antibiotic prescribing rate for children with diagnosis codes for pharyngitis, tonsillitis, and streptococcal sore throat (57% tested vs 73% not tested; P<.001).
Conclusions Physicians prescribed antibiotics to 53% of children with sore throat, in excess of the maximum expected prevalence of GABHS. Although there was a decrease in the proportion of children receiving antibiotics between 1995 and 2003, this was due to decreased prescribing of agents recommended for GABHS. Although GABHS testing was associated with a lower rate of antibiotic prescribing for children with diagnosis codes of pharyngitis, tonsillitis, and streptococcal sore throat, GABHS testing was underused.
Author Affiliations: Division of General Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass (Drs Linder and Bates); Center for Child Health Care Studies and Department of Ambulatory Care and Prevention, Harvard Medical School, and Harvard Pilgrim Health Care, Boston (Drs Lee and Finkelstein); and Divisions of Infectious Diseases (Dr Lee) and General Pediatrics (Dr Finkelstein), Children’s Hospital, Boston.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLES
Clinical Decision Support and Appropriateness of Antimicrobial Prescribing: A Randomized Trial
Matthew H. Samore, Kim Bateman, Stephen C. Alder, Elizabeth Hannah, Sharon Donnelly, Gregory J. Stoddard, Bassam Haddadin, Michael A. Rubin, Jacquelyn Williamson, Barry Stults, Randall Rupper, and Kurt Stevenson
JAMA. 2005;294(18):2305-2314.
ABSTRACT
| FULL TEXT
Appropriate Use of Antimicrobial Drugs: A Better Prescription Is Needed
J. Todd Weber
JAMA. 2005;294(18):2354-2356.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Performance of a Rapid Antigen-Detection Test and Throat Culture in Community Pediatric Offices: Implications for Management of Pharyngitis
Tanz et al.
Pediatrics 2009;123:437-444.
ABSTRACT
| FULL TEXT
Quality of Care for Common Pediatric Respiratory Illnesses in United States Emergency Departments: Analysis of 2005 National Hospital Ambulatory Medical Care Survey Data
Knapp et al.
Pediatrics 2008;122:1165-1170.
ABSTRACT
| FULL TEXT
Retail Clinics, Primary Care Physicians, And Emergency Departments: A Comparison Of Patients' Visits
Mehrotra et al.
Health Aff (Millwood) 2008;27:1272-1282.
ABSTRACT
| FULL TEXT
Quality of Care in the Retail Health Care Setting Using National Clinical Guidelines for Acute Pharyngitis
Woodburn et al.
American Journal of Medical Quality 2007;22:457-462.
ABSTRACT
Preventive Health Examinations and Preventive Gynecological Examinations in the United States
Mehrotra et al.
Arch Intern Med 2007;167:1876-1883.
ABSTRACT
| FULL TEXT
A Roadmap for National Action on Clinical Decision Support
Osheroff et al.
J. Am. Med. Inform. Assoc. 2007;14:141-145.
ABSTRACT
| FULL TEXT
Treatment of Adults With Acute Pharyngitis in Primary Care Practice--Reply
Linder and Bates
Arch Intern Med 2006;166:2292-2292.
FULL TEXT
Antibiotic use among children in British Columbia, Canada
Marra et al.
J Antimicrob Chemother 2006;58:830-839.
ABSTRACT
| FULL TEXT
Unnecessary Antibiotic Use Continues for Children with Sore Throat
JWatch Emergency Med. 2006;2006:4-4.
FULL TEXT
Appropriate Use of Antimicrobial Drugs: A Better Prescription Is Needed
Weber
JAMA 2005;294:2354-2356.
FULL TEXT
|
