Prescription of antibiotics for mild acute respiratory infections in children

ABSTRACT

Acute respiratory infections (ARI), the leading class of ailments causing people to seek health care, rarely require antibiotics. Nevertheless, many phisycians prescribe them needlessly. Hence, reducing the unnecessary use of antibiotics is one aim of any ARI control program. To help determine whether this aim might be achieved through a combination of refresher training for family phisycians and public education campaing, two 1991 interventions were carried out in four health areas (designated A, B, C and D) in the city of Habana, Cuba. In each area, 10 clinics staffed by family physicians were selected through simple random sampling. In two areas (A and B), a refresher training program on ARI for health personnel was instituted at each clinic, while in areas A and C a community education program was set up. No intervention was carried out in area D. Simultaneously, from January through Dicembre 1991 trained individuals visited and administered a standard questionnaire every 15 days to 1 600 families (40 per clinic) systematically selected by random sampling. The aim of this procedure was to record the number of ARI episodes ocurring among children under 5 years old, the treatment chosen in these cases, and whether antibiotics were employed. The results showed that when the two interventions were iniciated, antibiotics were prescribed for 26 per cent, 20 per cent, 11 per cent, and 19 per cent of the mild ARI cases occurring in areas A,B,C and D respectively (P 0.05). In the period immediately following the interventions, antibiotics prescription rates declined by 26 per cent and 63 per cent in areas A and B, while increasing by 2 per cent and 48 per cent in areas C and D. Overall, prescription of antibiotics in the intervention areas A and B combined decreased by 54 per cent (95 per cent CI 31-69 per cent). These data suggest that a refresher training program for health personnel can rapidly reduce the unnecessary prescribing of antibiotics for ARI cases, but that public education alone does not appear effective