Large-scale survey of parental antibiotic use for paediatric upper respiratory tract infections in China: implications for stewardship programmes and national policy

Int J Antimicrob Agents. 2021 Feb 12:106302. doi: 10.1016/j.ijantimicag.2021.106302. Online ahead of print.


BACKGROUND: Inappropriate use of antibiotics for upper respiratory tract infections among Chinese children is rampant. To identify key constructs for effective interventions targeting the public, we investigated parents' decision-making processes with respect to treatment choices and antibiotic use for paediatric URTIs.

METHODS: Data were collected between June 2017-April 2018 from a cluster random sample of 3,188 parents of children aged 0-13 across three Chinese provinces, representing different stages of economic development. Risk factors of parents' treatment choices and antibiotic use for paediatric URTIs were assessed, using binary and multinomial logistic regressions, adjusting for socio-demographic characteristics.

RESULTS: Of the 3,188 parents who self-diagnosed their children with a URTI, 46.0% children were given antibiotics, with or without prescription (n=1465). Among them, 40.5% were self-medicated with antibiotics by parents and 56.1% obtained further antibiotic prescriptions at healthcare facilities. About 70% of children with URTI symptoms sought healthcare (n=2197); of them, 54.8% obtained antibiotic prescriptions and 7.7% asked for antibiotic prescriptions with a 79.4% success rate to obtain them. Those perceiving antibiotics as effective for treating common cold and fever (aOR=1.82[1.51-2.19] and 1.77[1.47-2.13], respectively), who had access to non-prescription antibiotics (aOR=5.08[4.03-6.39]), and with greater perceived severity of infection (aOR=2.01[1.58-2.56]), were more likely to use antibiotics.

CONCLUSIONS: Context-appropriate multifaceted interventions are vital to untangle the perpetual problem of self-medication, over-prescription and ill-informed demands for antibiotics. Our findings emphasise the need to prioritise interventions enhancing clinical training, neutralising the pressure from patients for antibiotics, educating on appropriate home care, discouraging antibiotic self-medication, and improving antibiotic dispensing.

PMID:33588014 | DOI:10.1016/j.ijantimicag.2021.106302