Patologie delle alte vie respiratorie del bambino in ambulatorio: un'esperienza italiana. Diseases of the upper respiratory tract in children in ambulatory care: an Italian experience.

Background: Overuse of antibiotics for children is widespread and contributes to the emergence of antibiotic-resistant bacteria. Moreover, non steroidal antiinflammatory drugs (NSAIDs) are often overprescribed despite of their renal and gastrointestinal side-effects.

Objectives: To assess the behaviour and the factors influencing the prescribing practice of family pediatricians for the common upper respiratory diseases of pre-school children in an outpatient setting.

Methods: 125 family pediatricians, who provide primary care in an outpatient setting to young children in North-East of Italy (Veneto region), adhered to a survey consisting in a 40-item questionnaire about the factors that could influence their prescribing practice as regards otitis media (OM), pharyngitis (FGT) and broncopneumoniae (BPN) treatment of patients aged 0 to 5 years. Data were collected in November 2002. Descriptive analysis of data was performed using DELPHI TM7 professional Study Program.

Results: The child's age resulted an important factor, influencing the antibiotic prescription either in OM or in BPN. 86% of pediatricians emphasized the use of antipneumococcal vaccine, overall in children younger than 2 years with recurrent OM, while 71% adviced this vaccination in children younger than 5 years with relapsing BPN. The awareness of complications in OM and BPN often induced pediatricians to prescribe drugs. The most frequently prescribed antibiotic in OM, FGT and also BPN was amoxicillin for 7-10 days. According to the international guidelines, a small percentage (14%) of clinicians prescribe antibiotics for 5 days in OM, but most of them generally wait some hours to prescribe antibiotics. PenV was considered the most active drug in FGT and its disappearance from the market was considered negatively by italian pediatricians. Moreover, even if the rapid immunoenzymatic test for Group A beta-hemolyticus Streptococcus (GABHS) is considered sensitive, many pediatricians defined the throat culture the most accurate test to diagnose a GABHS pharyngitis. Paracetamol was frequently prescribed in these diseases, between 74% for OM and 53% for BPN. Among NSAIDs, niflumic acid and ibuprofen were the drugs most frequently prescribed in FGT and in OM respectively. About 30% of pediatricians refers that parents require drugs in the treatment of upper respiratory tract diseases.

Conclusions: Our results show that antibotics are generally not over-prescribed by italian pediatricians, but often prescribed for a long time, likely because of fear of complications and uncertainty of the diagnosis, particularly in OM, being not always available the pneumotoscope. About NSAIDs, niflumic acid is frequently not evidence-based used in Italy. Frequently, side-effects associated with NSAIDs administration were reported.