Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. e1104-e1110 (doi:10.1542/peds.2005-2443)
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Right arrow Infectious Disease & Immunity

Antibiotic Treatment of Wheezing in Children With Asthma: What Is the Practice?

Anita L. Kozyrskyj, PhDa,b,c, Matthew E. Dahl, BScb, Wendy J. Ungar, PhDd, Allan B. Becker, MDc and Barbara J. Law, MDc,e

a Faculty of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
b Department of Community Health Sciences, Manitoba Centre for Health Policy, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
c Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba
d Population Health Sciences, The Hospital for Sick Children; Department of Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
e Department of Medical Microbiology; Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

OBJECTIVE. Antibiotics are not recommended for the treatment of wheezing in children with asthma, but little is known about their use. This study was undertaken to evaluate trends and determinants of antibiotic use in children with wheezing during the fiscal years 1995 through 2001.

METHODS. Using the population-based health care and prescription databases in Manitoba, Canada, this descriptive study examined time trends in antibiotic prescription use for wheezing episodes in a population of children with asthma. The likelihood of receiving an antibiotic prescription according to child and physician characteristics also was determined. Annual population-based rates of antibiotic prescriptions for wheezing episodes were modeled by age and antibiotic class, using general estimating equations. The odds ratio for receiving an antibiotic prescription according to child demographics and physician factors was determined from hierarchical linear modeling.

Results. The antibiotic prescription rate for wheezing decreased by 28% from 708 prescriptions per 1000 children with asthma in 1995 to 511 prescriptions in 2001. Fifteen-fold increases in use were observed for broader spectrum macrolides in preschool children. Twenty-three percent of physician visits for wheezing resulted in an immediate antibiotic prescription, but this percentage increased to 64% for antibiotics that were received within 7 days of the episode. General practitioners prescribed antibiotics more often than did pediatricians. Physicians who were not trained in Canada or the United States were 40% more likely to prescribe antibiotics than their counterparts.

CONCLUSIONS. Antibiotic use for wheezing in children declined in the 1990s, but the increased use of broader spectrum macrolides has implications for antibiotic resistance. A link between antibiotic prescribing and physician specialty and location of training identifies opportunities for intervention.

Key Words: antibiotics • children • asthma • macrolides • trends • physician factors

Abbreviations: FY—fiscal year • NS—narrow-spectrum • BS—broader spectrum • OR—odds ratio • GP—general practitioner • CI—confidence interval

Accepted Dec 21, 2005.