Antibiotics use for upper respiratory tract infections among children in rural Anhui: children's presentations, caregivers' management, and implications for public health policy.

Children with upper respiratory tract infections (URTIs) are among the highest receivers of antibiotics. Using a retrospective cross-sectional study, we described clinical management in rural China of recent URTIs in children. We explored antibiotics using behaviors and associations of caregivers' variables and children's symptoms. Children with URTIs had a high consultation rate and a high prescription rate of antibiotics. For the children, some caregivers adopted, without rationale, 'self-medication' with antibiotics. Children with fever were more likely to be taken to a doctor; among those, children with particular symptoms were more likely to receive a prescription for antibiotics. Disseminating knowledge on antibiotics, and on interpretation and management of URTI symptoms will be important targets for caregiver and physician education and should become routine in training for physicians. Our findings also suggest the need to improve communication between doctors and caregivers, to strengthen regulation of drug sales, and to help caregivers learn when over-the-counter drug purchase without medical consultation is reasonable. These activities can help to improve health of a vast population of children in rural China.