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Uncertainty a factor in prescribing antibiotics for children

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New evidence on antibiotic prescribing trends has been revealed by UK researchers, including that “clinical uncertainty” is often a factor in deciding to issue a script.

The TARGET programme was set up to give clinicians the “tools they need” to better care for children with respiratory tract infections, the most common problem managed in primary care.

“This study suggests more evidence is needed to support clinical decision making”

Jeremy Horwood

The programme, led by Bristol Clinical Commissioning Group and the University of Bristol, identified new evidence it said would help parents, clinicians and policy makers support improved antimicrobial stewardship in primary care.

The main findings of the five-year research programme, funded by the National Institute for Health Research, are due to be presented in London today.

They include that an important driver of antibiotic prescribing was clinical uncertainty, with clinicians adopting a “treat just in case” strategy when they were unsure if a child’s condition could deteriorate.

A research paper from the TARGET programme was also published today in the British Journal of General Practice and supported the wider finding.

Based on semi-structured interviews conducted with 22 GPs and six nurses, it concluded that “prognostic uncertainty remains an important driver” of antibiotic prescribing.

“Experience and training in recognising severe respiratory tract infections, together with more evidence to help healthcare professionals identify the children at risk of future illness deterioration, may support identification of the children most and least likely to benefit from antibiotics,” said the researchers.

“Children with respiratory track infections often receive antibiotics, despite the fact that they will not help the majority”

Alastair Hay

Study author Dr Jeremy Horwood, a senior research fellow at Bristol’s Centre for Academic Primary Care, added: “This study suggests more evidence is needed to support clinical decision making and reduce diagnostic uncertainty and variation in antibiotic prescribing for childhood respiratory tract infections.”

Other findings due to be presented from the programme include that symptoms of respiratory tract infections in children last longer than many parents and clinicians expect – some for more than 21 days.

The study authors said this information was of “great value” to parents to help them know what to expect after seeing the doctor or nurse.

The most effective interventions to improve antibiotic use target both parents and clinicians during consultations, they said.

Other effective interventions included providing automatic prescribing prompts and employing delayed prescribing, the authors added.

University of Bristol

Uncertainty a factor in prescribing antibiotics for children

Alastair Hay

Professor Alastair Hay, who led the TARGET programme, said: “Children with respiratory track infections often receive antibiotics, despite the fact that antibiotics will not help the majority of children’s infections.

“Our research has uncovered why clinicians prescribe antibiotics… and what sorts of interventions would help improve the use of antibiotics in primary care,” he said. “With antimicrobial resistance an ever growing problem, we hope our research will go some way to tackle this issue.”

As well as presenting their findings, the researchers have launched two new websites to disseminate their findings, including one for clinicians and policymakers.

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