Antibiotic Overuse by Jamaican Clinicians in the Treatment of Pharyngitis in Children

Abstract

Background Overuse of antibiotics in pharyngitis management is an important global and local problem contributing to increased antibiotic resistance. We aimed to assess clinician attitudes towards the management of Group A Streptococcus (GAS) pharyngitis against objective diagnostic and prescribing practices. Methods A national cross-sectional survey was conducted among Jamaican public and private health clinicians. Their approach to patients with pharyngitis features was assessed and compared to medical records in the 0-15 year old age group from January 1 to December 31, 2018. Antibiotic prescribing rates were calculated for unlikely vs likely GAS pharyngitis (Centor <4 vs ?4). Findings 337 practitioners from 19 specialties were recruited. 308 (91?3%) reported managing presumed GAS pharyngitis (pharyngeal erythema, tonsillar erythema, tonsillar hypertrophy +/- exudates, anterior cervical lymphadenopathy, soft or hard palate petechiae). 301 (97?7%) reported inconclusive clinical features, while 45 (7?6%) reported no diagnostic challenge. Although 244 (72?4%) reported having a standard approach for using antibiotics, 99?1% expressed desire for local protocols for antibiotic use in pharyngitis.373 of 7,142 pharyngitis cases in 2018 were reviewed. 321 (86?1%) had sufficient documentation. Antibiotics were prescribed in 292 (91%) cases, including 213 (93?8%) of 227 where antibiotics were avoidable. Interpretation The clinical and social consequences of missing diagnoses may cause practitioners to prescribe antibiotics, even in cases of likely viral infections. High case rates of pharyngitis with concurrent antibiotic use pose a serious threat to antibiotic safety and susceptibility. However, clinical decision rules (CDRs) can reduce resistance risks, costs, adverse effects and promote confident management.