Immediate antibiotic prescribing habits for acutely ill children in primary care

Acute illness in pediatric patients is a common reason for visiting family physicians, meanwhile mostly children suffer from self – limiting viral infections which don’t require antibacterial treatment. Antibiotics are the most common administered prescription drugs for children, around 90% prescribed in primary care. C reactive protein (CRP) testing could reduce diagnostic uncertainty and antibiotic prescribing rates. The aim of this study is to explore whether CRP measurement could rationalize antibiotic prescribing for children with acute illnesses. The prospective observational study was conducted between November 2019 and May 2020. 80 family physicians from various Latvian regions were asked to record data (demographics, diagnosis , CRP level measurement, decision about antibiotic prescription) on pediatric patients aged 1 month  -  18 years who were consulted with acute infections. During 6 months period 2388 patients, with the mean age 6,07 years, were assessed. The most common infections were acute respiratory viral infection (ARVI) - 40,8%, otitis - 32.6%, acute bronchitis - 15.8%. The major groups of infections treated with antibiotics were otitis - 44.8%, acute bronchitis -25.2% and ARVI -14,6%. For 47.2% (n=1126) CRP testing was performed before antibiotic prescribing. CRP level < 20 mg/l was detected in 77,8% (n=876) patients, only in 6,1% (n=68) CRP level > 50 mg/l (n=68). In patient population tested for CRP, antibiotics were prescribed immediately in 31.2% cases. In children group treated with antibiotics, CRP level was < 20 mg/l for 48,1% (n=169) and >50 mg/l for 16,5% (n=58). Antibiotics in primary care are overused and often prescribed for self-limiting infections when CRP measurements are below the level indicating bacterial infection. Reliable cut-off levels of CRP to distinguish children with self-limiting viral infections from those who benefit from antibacterial treatment and guidelines could make this method more useful to reduce antibiotic prescribing.