A practical tool for primary care antimicrobial stewardship in children

Respiratory tract infections are the single most important cause of consultations in primary care.1 Approximately 60% of 0–4 year-olds and 30% of 5–15 year-olds present with an acute respiratory infection at least once a year,1 positioning the primary care consultation for respiratory tract infection as a high-profile target for antimicrobial stewardship initiatives. However, despite national and international calls for more targeted use,2 primary care prescription of antibiotics for coughs and colds increased by 40% in the UK between 1999 and 2011,3 in part reflecting the uncertainties facing patients, parents, and health-care professionals when managing these common but potentially life-threatening infections.

Safety assessments of no antibiotic prescription initiatives for respiratory tract infections will play an important part in gaining public acceptance and successful uptake in practice.4 Present evidence remains equivocal, suggesting that insufficiently informed reductions in antibiotic prescription in primary care might increase rates of pneumonia diagnosis,5 hospital admissions, and even mortality.6 Yet decreased prescribing rates have also been shown to have little effect on rates of rare complications such as mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome.5 Tools that inform antibiotic use according to individualised patient risk profiles could help to realise the benefits of antibiotic stewardship programmes in primary care while minimising potential risks.