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Interventions
Interventions to reduce childhood antibiotic prescribing for upper respiratory infections: systematic review and meta-analysis
  1. Yanhong Hu1,
  2. John Walley2,
  3. Roger Chou3,
  4. Joseph D Tucker4,
  5. Joseph I Harwell5,
  6. Xinyin Wu1,
  7. Jia Yin1,
  8. Guanyang Zou6,
  9. Xiaolin Wei1,6,7
  1. 1The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong (CUHK), Hong Kong, China
  2. 2Nuffield Centre for International Health, LIHS, University of Leeds, Leeds, UK
  3. 3Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
  4. 4UNC Project-China, Guangzhou, China and International Diagnostics Centre, London School of Hygiene and Tropical Medicine, London, UK
  5. 5Clinton Health Access Initiative, Boston, Massachusetts, USA
  6. 6China Global Health Research and Development, Shenzhen, China
  7. 7Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Professor Xiaolin Wei, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Ontario, Canada M5T 3M7; xiaolin.wei{at}utoronto.ca

Abstract

Background Antibiotics are overprescribed for children with upper respiratory infections (URIs), leading to unnecessary expenditures, adverse events and antibiotic resistance. This study assesses whether interventions antibiotic prescription rates (APR) for childhood URIs can be reduced and what factors impact intervention effectiveness.

Methods MEDLINE, Embase, Google Scholar, Web of Science, Global Health, WHO website, United States CDC website and The Cochrane Central Register of Controlled Trials (CENTRAL) were searched by December 2015. Cluster or individual-patient randomised controlled trials (RCTs) and non-RCTs that examined interventions to change APR for children with URIs were selected for meta-analysis. Educational interventions for clinicians and/or parents were compared with usual care.

Results Of 6074 studies identified, 13 were included. All were conducted in high-income countries. Interventions were associated with lower APR versus usual care (OR 0.63 (95% CI 0.50 to 0.81, p<0.001). A patient–clinician communication approach was the most effective type of intervention, with a pooled OR 0.41 (95% CI 0.20 to 0.83; p<0.001) for clinicians and 0.26 (95% CI 0.08 to 0.91; p=0.04) for parents. Interventions that targeted clinicians and parents were significant, with a pooled OR of 0.52 (95% CI 0.35 to 0.78; p=0.002). Insignificant effects were observed for targeting clinicians and parents alone, with a pooled OR of 0.88 (95% CI 0.67 to 1.16; p=0.37) and 0.50 (95% CI 0.10 to 2.51, p=0.40), respectively.

Conclusions Educational interventions are effective in reducing antibiotic prescribing for childhood URIs. Interventions targeting clinicians and parents are more effective than those for either group alone. The most effective interventions address patient–clinician communication. Studies in low-income to middle-income countries are needed.

  • CHILD HEALTH
  • HEALTH PROMOTION
  • PUBLIC HEALTH
  • METHODOLOGY

https://doi.org/10.1136/jech-2015-206543

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    Footnotes

    • Contributors YH designed the study, screened the paper, extracted and analysed data, wrote the manuscript and approved the final manuscript as submitted. JW wrote the manuscript, interpreted the data and approved the final manuscript. JIH wrote the manuscript, interpreted the data and approved the final manuscript. RC reviewed the revised manuscript and approved the final manuscript as submitted. JDT reviewed the revised manuscript and approved the final manuscript as submitted. GZ reviewed the revised manuscript and approved the final manuscript as submitted. XW reviewed the revised the manuscript and approved the final manuscript as submitted. JY reviewed the revised manuscript and approved the final manuscript as submitted. XW designed the study, extracted data, analysed and interpreted the results, wrote the manuscript and approved the final manuscript as submitted.

    • Funding This work was supported by Medical Research Council, Global Health Trials developmental grant—funding reference number: MR/M022161/1.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.