Non-adherence to antibiotic prescription guidelines in treating urinary tract infection of children: a population-based study in Taiwan.

OBJECTIVES

Inappropriate use of antibiotics may increase antibiotic resistance and health care service load. Few studies have been conducted to investigate physician non-adherence to antibiotic prescription guidelines for treating urinary tract infections (UTIs) in child patients. This study aimed to examine the rates of and factors associated with non-adherence to antibiotic prescription guidelines for treating uncomplicated UTIs in child patients.

METHODS

This is a cross-sectional study in which a random sample of 8921 children who received antibiotics prescription for UTIs (ICD-9-CM: 590.1, 595.0, 595.9 or 599.0) at age 17 years or less, between 2000 and 2007, were analysed. Data analysed were retrieved from Taiwan's National Health Insurance database. Non-adherence was determined by antibiotic prescription not recommended by the Infectious Disease Society of Taiwan. Multivariate logistic regression model was employed to assess the potential predictors for non-adherence, including various characteristics of patients, physicians and medical institutions.

RESULTS

The overall non-adherence rate was estimated at 20.05%. Older patients, older physicians and physicians from community clinics were associated with higher rates of non-adherence. Compared with pediatricians who had the lowest rate (13.15%) of non-adherence, certain specialties were found to have significantly elevated adjusted odds ratio (AOR) of non-adherence, with the highest one noted for gynecologists (35.11%, AOR = 2.29, 95% confidence interval: 1.89-2.77). We also observed that the most frequently prescribed antibiotics not recommended on guidelines varied with physician specialty.

CONCLUSIONS

Special attention should be concentrated on older physicians, gynecologists and physicians who practiced at community clinics to reduce non-adherence of antibiotic prescription for treating UTIs in child patients.