The decision-making process in antibacterial treatment of pediatric upper respiratory infections: a national prospective office-based observational study

Background: The identification of patient management practices and the sources of medical information is crucial for rationalizing the treatment of respiratory tract infections, whose high incidence, especially in children, makes them one of the maior areas of unnecessary health expenditure. Materials and Methods: This national prospective study was designed to investigate the diagnostic and prescribing habits of 100 office-based pediatricians managing upper respiratory tract infections in 1111 pediatric patients (604 males, mean age 6.79±2.77 years; 507 females, mean age 6.73±2.8 years) sequentially enrolled when an antibiotic treatment was deemed necessary. Results: The most frequently diagnosed diseases were acute tonsillopharyngitis (56.2%) and acute otitis media (18.1%). Penicillins were prescribed in 34.3% of the cases, cephalosporins in 38.1%, and macrolides in 26.1%: oral drugs accounted for 92.2% of the prescriptions. The treatments were administered once or twice daily in 75.8% of the patients, and prescribed for ≥8 days in more than 80%; 76.7% also received supportive or symptomatic treatment (antipyretics, corticosteroids, cough suppressants and non-steroidal anti-inflammatory drugs). Laboratory or radiologic investigations were rarely requested. The main sources of medical information indicated by the participating pediatricians were pharmaceutical companies (35.6%) and meeting or congress reports (27.3%). Conclusions: The results indicate that more active education is still needed to improve the decision-making processes of office-based pediatricians.