Dialogue Around Respiratory Illness Treatment

Antibiotic prescribing for childhood ARTIs, including acute otitis media (AOM), sinusitis,
bronchitis, upper respiratory infection (URI), and pharyngitis is common in the United
States. An estimated 31.7 million visits for respiratory conditions result in antibiotic
prescriptions annually, accounting for >70% of outpatient visits during which antibiotics are
prescribed to children. Current national levels of antibiotic prescribing for ARTIs appear
excessive given the estimated prevalence of these infections caused by bacterial pathogens in
children. While a number of studies in the early 2000's indicated that inappropriate
antibiotic prescribing may have peaked in the 1990's these declining prescribing rates were
primarily driven by decreased rates of office visits for ARTIs and decreased prescribing for
cases where antibiotics are rarely needed (i.e., acute nasopharyngitis, laryngitis, URI,
bronchitis, bronchiolitis, viral pneumonia, and influenza).

For patients presenting with presumed bacterial ARTIs (i.e., AOM, sinusitis, Group A
Streptococcal (GAS) pharyngitis, and non-viral pneumonia), overall prescribing rates remained
stable during the decade spanning 1995 to 2006 while second-line antibiotic prescribing
increased. This has occurred despite the recent development of treatment guidelines outlining
first- and second-line alternative treatments for bacterial ARTIs. Between 1995 and 2006,
prescription rates of azithromycin (a second-line agent) for ARTIs increased almost 9-fold
for children < 5 years-old. Similarly, for children ≥5 years-old, azithromycin and
fluoroquinolone prescription rates increased approximately 6- and 5-fold, respectively.
During this same time period, use of amoxicillin, the first-line agent for most ARTIs,
decreased by 37% for children <5 years-old and by 49% for those ≥5 years-old with ARTIs.
Furthermore, it is widely accepted that episodes of bronchitis and URI in children are caused
by viral pathogens and that antibiotic treatment does not alter the course of those diseases
or prevent future bacterial infections. Overuse of antibiotics for such conditions
contributes to increased resistance among many strains of bacteria that commonly cause ARTIs,
posing risks at both the individual and community levels. The large number of annual visits
for pediatric ARTIs and the frequency of antibiotic prescribing during those visits make
ARTIs an important target for efforts to reduce antibiotic overuse.

Inclusion Criteria:

- Provider from a participating practice in the NorthShore University HealthSystem or
PROS network, which is a national research network of primary care providers who care
for children founded by the American Academy of Pediatrics in 1986.

Exclusion Criteria:

- Providers will be excluded if they are not from a participating practice as described
above.