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Clinical Question:
Does more cautious prescribing of antibiotics for sore throat increase the
number of children with serious complications?
Bottom Line:
More judicious prescribing of antibiotics for childhood respiratory
infections has not increased the number of episodes of peritonsillar abscess
or rheumatic fever. The effect on mastoidectomy is unclear, but a clinically
important increase appears unlikely.
Reference:
Sharland M, Kendall H, Yeates D, et al. Antibiotic prescribing in general
practice and hospital admissions for peritonsillar abscess, mastoiditis, and
rheumatic fever in children: time trend analysis. BMJ 2006;331:328-29.
Study Design:
Ecologic
Synopsis:
In the United Kingdom, as in the United States, physicians are prescribing
fewer antibiotics for acute respiratory conditions in children. This is a
laudable trend, but some researchers have speculated that the use of fewer
antibiotics may increase the risk of very rare but serious problems, such as
mastoiditis, peritonsillar abscess, and rheumatic fever. The authors used
data from a national database of drugs dispensed by pharmacists, a primary
care database for 130 practices, and a database of hospital admissions. They
found that antibiotic prescribing by physicians declined by approximately
35% between 1993 and 1999 and then leveled off; the number of prescriptions
filled continued to decline by another 9% in 4 years, probably because of
increased use of delayed prescriptions as a strategy to reduce inappropriate
antibiotic usage. During the same period (1993 to 2003), there was no change
in the rate of hospital admissions for peritonsillar abscess or rheumatic
fever, but a small rise in the rate of admission (19%) for mastoidectomy.
However, there was a trend toward a declining number of episodes of
mastoidectomy in general practices. Also, most of the increase in hospital
episodes of mastoidectomy were in children younger than age 4, an age when
otitis media is most common.
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