Primary Care Service, Regional Health Authority of Emilia-Romagna, Viale Aldo Moro 21, 40127, Bologna, Italy.
Regional Health and Social Agency of Emilia-Romagna, Bologna, Italy.
Eur J Pediatr. 2021 Apr;180(4):1185-1192. doi: 10.1007/s00431-020-03861-8. Epub 2020 Nov 3.
Acute otitis media (AOM) and sore throat are common reasons for antibiotic prescription in children. Starting from 2007, evidence-based guidelines and other multifaceted improvement activities (ProBA project) were implemented in Emilia-Romagna, a northern Italian region. Antibiotic prescription rate in the region decreased with time (37% relative reduction from 2005 to 2019). Within the ProBA project, this retrospective observational study, including all hospitals of the region, aims to assess if lower rate of antibiotic prescription was associated with an increased rate of acute mastoiditis and acute rheumatic fever (ARF). Hospital admission rates for acute mastoiditis and ARF from 2005 to 2019 were calculated using ICD-9 codes. Hospital intervention rates for myringotomy, incision of mastoid, and mastoidectomy were also assessed. A comparison with antibiotic prescription rate in the pediatric population was performed. Data were gathered using administrative databases and trends were calculated using Poisson regression. During the study period, rate of mastoiditis and similar diagnosis declined from 54.1 to 33.6 per 100.000 (β coefficient = - 0.047, p value < 0.001) and rate of surgical treatment from 134.6 to 89.6 per 100.000 (β coefficient = - 0.036, p value < 0.001), whereas rate of ARF remained stable at around 4.4-4.8 per 100.000 (β coefficient = - 0.009, p value = 0.472).Conclusion: ProBA project implementation-recommending 5 days of amoxicillin for AOM when needed and 6 days of amoxicillin when streptococcal pharyngitis is detected-was associated with a reduced antibiotic use without an increase of complications. What is Known: • Acute otitis media (AOM) and streptococcal pharyngitis are common pediatric infections and frequent cause of antibiotics prescription. • Fear of rare complications like mastoiditis and acute rheumatic fever can hinder health professionals' compliance with evidence-based guideline. What is New: • Guidelines recommending a short course of antibiotics for AOM and streptococcal pharyngitis are associated with reduced antibiotic prescriptions and no increase of complications. • Analysis based on administrative databases is useful for monitoring projects and supporting health professionals in complying with guidelines.
急性中耳炎（AOM）和喉咙痛是儿童开具抗生素处方的常见原因。自 2007 年以来，意大利北部艾米利亚-罗马涅地区实施了基于证据的指南和其他多方面的改进活动（ProBA 项目）。该地区的抗生素处方率随时间呈下降趋势（2005 年至 2019 年相对减少 37%）。在 ProBA 项目中，这项回顾性观察研究包括该地区的所有医院，旨在评估较低的抗生素处方率是否与急性乳突炎和急性风湿热（ARF）的发生率增加有关。2005 年至 2019 年，使用 ICD-9 代码计算急性乳突炎和 ARF 的住院率。还评估了鼓膜切开术、乳突切开术和乳突切除术的医院干预率。与儿科人群中的抗生素处方率进行了比较。使用行政数据库收集数据，并使用泊松回归计算趋势。在研究期间，乳突炎和类似诊断的发生率从每 100,000 人 54.1 例降至 33.6 例（β系数=-0.047，p 值<0.001），手术治疗率从每 100,000 人 134.6 例降至 89.6 例（β系数=-0.036，p 值<0.001），而 ARF 的发生率保持在每 100,000 人约 4.4-4.8 例（β系数=-0.009，p 值=0.472）不变。结论：ProBA 项目的实施——当需要时推荐使用 5 天阿莫西林治疗 AOM，当检测到链球菌性咽炎时推荐使用 6 天阿莫西林——与抗生素使用减少而无并发症增加有关。已知情况：•急性中耳炎（AOM）和链球菌性咽炎是常见的儿科感染，也是抗生素处方的常见原因。•担心罕见并发症，如乳突炎和急性风湿热，可能会阻碍卫生专业人员遵守基于证据的指南。新情况：•推荐用于 AOM 和链球菌性咽炎的短期抗生素治疗指南与抗生素处方减少且无并发症增加有关。•基于行政数据库的分析有助于监测项目并支持卫生专业人员遵守指南。
