Unnecessary antimicrobial prescribing for upper respiratory tract infections in children in Pietermaritzburg, South Africa

Background: Acute upper respiratory tract infections (URTIs) are contagious diseases of the upper airways, but they are self-limiting in nature. Therefore, antimicrobial-use for the majority of the URTIs is considered inappropriate. Unfortu- nately, globally, antimicrobials are still being prescribed for the treatment of URTIs, especially in children. However, there is insufficient evidence on the causes of this phenomenon in South Africa. Objective: To investigate whether the parents/guardians accompanying children with URTIs expected/influenced physi- cians and/or nurses to prescribe antibiotics. Methods: This was a prospective descriptive and explorative questionnaire-based study. Participants were guardians who accompanied children aged five years and below, diagnosed with acute URTIs. Findings: Three hundred and six parents/guardians participated in this study. Seventy six percent (n=233) of participants received antibiotics for URTIs for their children, and 67% (n=156) of these did not make requests for antimicrobial therapy. On overall, there was a statistically significant (p < 0.0001) chance (with OR of 5.9; 95% CI, 2.4 – 14.2) for receiving antibi- otics for URTIs without a request. Conclusion: Physicians and other healthcare providers need education on rational prescribing of antimicrobials, and to implement evidence-based standard treatment guidelines, to reduce inappropriate use of antibiotics in children with self-lim- iting URTIs. Keywords: Antibiotics; antimicrobials; prescribing; upper respiratory tract infections; children.