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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

Bacterial Prevalence and Antimicrobial Prescribing Trends for Acute Respiratory Tract Infections

Matthew P. Kronman, Chuan Zhou and Rita Mangione-Smith
Pediatrics September 2014, peds.2014-0605; DOI: https://doi.org/10.1542/peds.2014-0605
Matthew P. Kronman
Divisions of aInfectious Diseases and
Centers for bClinical and Translational Research and
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Chuan Zhou
cGeneral Pediatrics, Department of Pediatrics, University of Washington, Seattle, Washington; and
dChild Health, Behavior, and Development, Seattle Children’s Hospital Research Institute, Seattle, Washington
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Rita Mangione-Smith
cGeneral Pediatrics, Department of Pediatrics, University of Washington, Seattle, Washington; and
dChild Health, Behavior, and Development, Seattle Children’s Hospital Research Institute, Seattle, Washington
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Abstract

BACKGROUND AND OBJECTIVES: Antimicrobials are frequently prescribed for acute respiratory tract infections (ARTI), although many are viral. We aimed to determine bacterial prevalence rates for 5 common childhood ARTI - acute otitis media (AOM), sinusitis, bronchitis, upper respiratory tract infection, and pharyngitis- and to compare these rates to nationally representative antimicrobial prescription rates for these ARTI.

METHODS: We performed (1) a meta-analysis of English language pediatric studies published between 2000 and 2011 in Medline, Embase, and the Cochrane library to determine ARTI bacterial prevalence rates; and (2) a retrospective cohort analysis of children age <18 years evaluated in ambulatory clinics sampled by the 2000–2010 National Ambulatory Medical Care Survey (NAMCS) to determine estimated US ARTI antimicrobial prescribing rates.

RESULTS: From the meta-analysis, the AOM bacterial prevalence was 64.7% (95% confidence interval [CI], 50.5%–77.7%); Streptococcus pyogenes prevalence during pharyngitis was 20.2% (95% CI, 15.9%–25.2%). No URI or bronchitis studies met inclusion criteria, and 1 sinusitis study met inclusion criteria, identifying bacteria in 78% of subjects. Based on these condition-specific bacterial prevalence rates, the expected antimicrobial rescribing rate for ARTI overall was 27.4% (95% CI, 26.5%–28.3%). However, antimicrobial agents were prescribed in NAMCS during 56.9% (95% CI, 50.8%–63.1%) of ARTI encounters, representing an estimated 11.4 million potentially preventable antimicrobial prescriptions annually.

CONCLUSIONS: An estimated 27.4% of US children who have ARTI have bacterial illness in the post-pneumococcal conjugate vaccine era. Antimicrobials are prescribed almost twice as often as expected during outpatient ARTI visits, representing an important target for ongoing antimicrobial stewardship interventions.

  • infectious diseases epidemiology
  • otitis media
  • Accepted July 24, 2014.
  • Copyright © 2014 by the American Academy of Pediatrics

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Pediatrics
Vol. 147, Issue 1
1 Jan 2021
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Bacterial Prevalence and Antimicrobial Prescribing Trends for Acute Respiratory Tract Infections
Matthew P. Kronman, Chuan Zhou, Rita Mangione-Smith
Pediatrics Sep 2014, peds.2014-0605; DOI: 10.1542/peds.2014-0605

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Bacterial Prevalence and Antimicrobial Prescribing Trends for Acute Respiratory Tract Infections
Matthew P. Kronman, Chuan Zhou, Rita Mangione-Smith
Pediatrics Sep 2014, peds.2014-0605; DOI: 10.1542/peds.2014-0605
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Subjects

  • Infectious Disease
    • Infectious Disease
    • Epidemiology
  • Ear, Nose & Throat Disorders
    • Otitis Media
    • Ear, Nose & Throat Disorders

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