Prescribing of antibiotics for respiratory tract infections in German outpatient pediatric care: Results of a survey of pediatricians and general practitioners

Abstract

Background: Pediatric outpatients with respiratory tract infections (RTIs) comprise an important target population for antibiotic stewardship (ABS) intervention. Objectives: The aim of this qualitative study was to determine which clinical and contextual factors have a significant impact on antibiotic therapy (ABT) in pediatric patients with RTIs. Materials and methods: An online survey was developed and carried out in Germany in cooperation with the Federal Association of Pediatricians and the German Society for Pediatric Infectious Diseases. Pediatricians and general practitioners were invited to participate. Results: The survey yielded 555 complete response data sets. Diagnostic uncertainty, time constraints for repeated consultations, and fear of complications were identified by 50% of both medical specialties as contextual factors fostering ABT. The risk of serious complications (e.g., mastoiditis) was overestimated by the majority of participants. More than 40% of respondents lacked knowledge concerning official guidelines, and RTIs with fever lasting longer than three days appeared to be an important criterion for ABT for 30–40%. Fewer than 60% of physicians were using a point-of-care device to determine C‑reactive protein. Conclusion: Although most participants acknowledged the growing prevalence of antibiotic-resistant pathogens as an important problem, this survey identifies targets for ABS in pediatric outpatients with RTIs. Ongoing education and training (e.g., better communication strategies in response to parental concerns) should become mandatory for those who prescribe ABT for children with RTIs.