Acute Tonsillitis and Bronchitis in Russian Primary Pediatric Care: Prevailing Antibacterial Treatment Tactics and Their Optimization

摘要

Inappropriate use of antibiotics in children with acute tonsillitis (AT) and bronchitis is an important cause of the microbial resistance. The aim of the study was to find out pediatricians' motives in prescribing antibiotics and the extent of their inappropriate use in these cases, as well as maternal attitudes to the use of antibiotics in acute viral respiratory infections (ARI). We also studied in the context of regular primary pediatric care the acceptability to parents of a judicious use of antibiotics. Pediatricians (n=97) attitudes to antibiotics and their practices were studied by a questionnaire in 4 cities of Russia, mothers' attitudes to antibiotics (n=107) and antibiotic use frequencies were studied in an Oryol polyclinic. Optimization of treatment studies (acute tonsillitis 1577 child-years, acute bronchitis 3303 child-years of observations) were conducted by two co-authors in their capacity of primary pediatric providers (for about a 1000 children each) in a polyclinics of Oryol. Antibiotics were given only to AT cases found positive for hemolytic streptococcus (GABHS) by an express-test. Patients with acute bronchitis and bronchiolitis were treated by inhalation of 0.9% or 3% saline solutions. Most (95-100%) pediatricians consider tonsillitis (without bacteriological evidence obtained at the point of care) to be of bacterial origin and treat it with antibiotics - for the fear of GABHS complications, self-protection or as a traditions. About a half of mothers would add antibiotics to whatever else pediatrician prescribes for ARI, 1/3 mothers prefer self-treatment with antibiotics if body temperature is over 38℃. Of tonsillitis patients 80.5% and of bronchitis over 70% - are treated in the outpatient setting with antibiotics. The incidence of tonsillitis was 80 per 1000 children of all ages, the proportion of GABHS-tonsillitis - 27% - only in children above 4 years of age (population incidence 7.5 per 1000). 87% of mothers of GABHS negative children accepted treatment without antibiotics. Similarly, 88.5% of parents of children with bronchiolitis (incidence 113 per 1000 0-2 years old) and acute bronchitis (61 per 1000 0-18 years old) agreed to use only saline inhalations. We conclude that additional attention to mothers (explaining results of the express-test, or teaching how to do inhalation) overcome their fears of withholding antibiotics.