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Antimicrobial use in febrile children diagnosed with respiratory tract illness in an emergency department


The Pediatric Infectious Disease Journal: December 1999 - Volume 18 - Issue 12 - p 1078-1080
Original Studies

Background. In an era of increasing antibiotic resistance, the prevalence of antibiotic usage and associated factors should be ascertained to optimize their use. We set out to determine the prevalence of antibiotic use in febrile children diagnosed with respiratory tract illnesses at a children's hospital emergency department; to determine how often viral studies were conducted; and to identify patient characteristics associated with antibiotic use.

Methods. We conducted a retrospective study of antibiotic use in febrile children 3 months to 10 years old presenting with respiratory illnesses during two 1-month periods. Patient charts and laboratory tests were reviewed. Antibiotic use was related to diagnosis by logistic regression.

Results. A total of 836 patient visits were selected. Antibiotics were prescribed for otitis media in 96% of patients, for pneumonia in 100%, for pharyngitis in 66%, for bronchiolitis in 38%, for reactive airway disease in 24% and for viral or "upper respiratory tract illness" in 14%. For viral illness or upper respiratory tract infection, antibiotic use was associated with a fever duration of >48 h [odds ratio (OR), 3.2; 95% confidence interval (CI) 1.7, 5.9] and having a chest radiograph performed (OR 2.1; 95% CI 1.02, 4.37). Patients with pharyngitis who had a throat swab were less likely to receive an antibiotic (OR 0.08; 95% CI 0.02, 0.4) than those who did not have a swab. In this emergency department antibiotic use for these indications decreased by 11% during the 1997 to 1998 study interval (P < 0.001).

Conclusion. Antibiotics were commonly prescribed for pharyngitis, bronchiolitis and reactive airway disease, which are conditions principally caused by viruses. Addressing reasons why there is a difference between guidelines and antibiotic use in these conditions may be important.

From the Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa (NLS, CB, CP), and Children's Hospital of Eastern Ontario Research Institute (BP, CP), Ottawa, Ontario, Canada.

Accepted for publication Sept. 8, 1999.

Address for reprints: Nicole Le Saux, M.D., F.R.C.P.C., Division of Infectious Diseases, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1. Fax 613-738-4832; E-mail

© 1999 Lippincott Williams & Wilkins, Inc.