Last updated on Sep 30th, 2016 at 09:55 am

A new study of over 8 000 children has identified seven key predictors which could help general practitioners (GPs) and nurses in primary care identify low risk children who are less likely to need antibiotics, according to new research published in The Lancet Respiratory Medicine on 1 September 2016.

Cough is most common infection

Respiratory infections with cough is the most common reason people go to the doctor and the most frequent reason given for primary care antibiotic prescribing in children. Yet it is challenging for GPs and primary care nurses to easily identify serious respiratory infections, and up to a third of antibiotics prescribed in primary care are considered unnecessary.

Resistance to antibiotics

“Excessive antibiotic use has contributed to the development of resistance to these drugs”, explains lead author Professor Alastair Hay from the University of Bristol, Bristol, UK. “The aim of our study was to develop a simple, usable prediction tool based on symptoms and signs to help GPs and nurses identify children presenting in primary care at the lowest and highest risk of future complications and hospitalisation, so that antibiotics can be targeted accordingly.”

Seven characteristics

To create the tool, Hay and colleagues showed that seven characteristics were independently linked with hospitalisation: short illness; temperature; age; signs of distress; wheeze; asthma; and, vomiting.

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Using these findings, the authors then developed a seven-item scoring system for a child’s risk of future hospitalisation. 

No antibiotics for low-risk children

According to the authors, a ‘no antibiotic’ prescribing strategy would be appropriate for low risk children; whilst a ‘no antibiotic or delayed antibiotic’ treatment strategy would be best for normal risk children; and children deemed at high risk of hospitalisation should be closely monitored for signs of deterioration and followed-up within 24 hours.

Rule supplements clinical judgement

“We hope that our proposed clinical tool might eventually enable doctors to quickly and easily identify their lowest and highest risk patients. … The rule should supplement not replace clinical judgement, and doctors and nurses should still advise parents about the symptoms and signs they should look out for, and when to seek medical help,” concludes Professor Hay.

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