(HealthDay News) — Just over one-quarter of U.S. children with acute respiratory tract infections (ARTI) have bacterial illness, yet antimicrobials are prescribed twice as frequently as expected during ARTI outpatient visits, according to a study published online September 15 in Pediatrics.

Matthew P. Kronman, MD, from the University of Washington in Seattle, and colleagues conducted a systematic literature review and meta-analysis to identify ARTI bacterial prevalence rates. These rates were then applied in a retrospective analysis of data from the National Ambulatory Medical Care Survey (NAMCS) of children evaluated from 2000–2010 in ambulatory clinics to determine the estimated U.S. ARTI antimicrobial prescribing rates.

The researchers found in the meta-analysis that the acute otitis media bacterial prevalence was 64.7%. During pharyngitis, Streptococcus pyogenes prevalence was 20.2%. There were no upper respiratory infection or bronchitis studies included, but the one sinusitis study identified bacteria in 78% of subjects. The expected antimicrobial prescribing rate for ARTI overall was 27.4%, based on these condition-specific bacterial prevalence rates. However, in NAMCS, antimicrobial agents were prescribed in 56.9% of ARTI encounters, representing an estimated 11.4 million potentially preventable antimicrobial prescriptions annually.

“Antimicrobials are prescribed almost twice as often as expected during outpatient ARTI visits, representing an important target for ongoing antimicrobial stewardship interventions,” the authors write.

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