Researchers uncover GPs’ dilemma over prescribing antibiotics for children with respiratory tract infections

Researchers from the University of Bristol’s Centre for Academic Primary Care have investigated the reasons behind GPs’ antibiotic prescribing decisions for children with RTIs.

GPs find making decisions about prescribing antibiotics in children with respiratory tract infections (RTIs) difficult – on the one hand, the over-prescription of antibiotics is recognised as a serious concern but, on the other, treating a significant infection may require antibiotics.

Primary care practitioners such as GPs are responsible for 80% of all antibiotic prescriptions in the UK and around half of these are for RTIs, despite the fact that their effectiveness in treating RTIs has been shown to be limited.

Now researchers from the University of Bristol’s Centre for Academic Primary Care have uncovered the reasons behind these antibiotic prescribing decisions for children with RTIs.

Dr Jeremy Horwood and his colleagues interviewed 22 GPs and six nurses to try and find out what is driving antibiotic prescribing for children’s RTIs. They describe their findings in a paper published on 26 February in the British Journal of General Practice. They found decisions to prescribe antibiotics were based on a combination of symptoms and signs, which varied between clinicians. Findings suggested that clinicians were confident in diagnosing and managing the majority of minor and severe RTIs, but some clinicians stated they may prescribe antibiotics for all those children they deemed the most serious, because it was not possible to differentiate between a viral or bacterial cause.

Clinical uncertainty could also be an important driver of antibiotic prescribing. Children perceived to be of intermediate illness severity provoked the most uncertainty, and clinicians often chose to prescribe antibiotics “just in case” than risk not prescribing for a child who might subsequently become seriously ill.

When describing how they reached a decision to prescribe antibiotics, clinicians identified additional influences other than parent-reported symptoms and physical examination findings. Pressure from parents for antibiotics was rare, but concerns such as a parent may not re-consult if their child deteriorated also influenced decisions to prescribe antibiotics.

Dr Horwood, a senior research fellow at the Centre for Academic Primary Care said:

“This study suggests more evidence is needed to support clinical decision making and reduce diagnostic uncertainty and variation in antibiotic prescribing for childhood RTIs. Clinicians require more detailed evidence about the prognosis of RTIs in children to help them identify the children at greatest risk of future illness deterioration. This will enable them to determine the children most and least likely to benefit from antibiotics and to increase confidence in non-antibiotic treatment strategies rather than prescribing in the face of uncertainty.”

The work was carried out as part of the NIHR-funded TARGET Programme, a five year research programme aimed at improving the quality of care given to children presenting to primary care with RTIs.

Further information

Paper

Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs: a qualitative interview study
Jeremy Horwood, Christie Cabral, Alastair D Hay, Jenny Ingram
British Journal of General Practice

The TARGET Programme is funded by the National Institute for Health Research’s Programme Grant for Applied Research (NIHR PGfAR) Programme (Grant Reference Number RP-PG-0608-10018).