Antibiotic Prescription in Febrile Children : A Cohort Study during Out-of-Hours Primary Care

Background: Fever is common in children and often self-limiting, nevertheless antibiotics are frequently prescribed. We determined how often antibiotics were prescribed in children presenting with fever at a family physicians’ out-of-hours service and established the children’s signs and symptoms related to antibiotic prescriptions. Patients: Children aged 3 months to 6 years with fever as the main reason for contact. Results: Of the 443 included children, 322 children had a face-to-face contact at the out-of-hours service. Of these, 117 (36.3%) were prescribed antibiotics, that is, 26.5% of the total study population. Concerned parents (OR, 2.02; 95% CI, 1.06–3.58), ill appearance (3.26; 1.30–8.20), earache resulting in altered behavioral or sleeping patterns (2.59; 1.06–6.30), signs of throat infection (2.37; 1.35– 4.15), and decreased urine production (2.00; 1.17–3.41) were positively associated with antibiotic prescription. A negative association was found for age 3 to 6 months (0.17; 0.03–0.74) and temperature (0.52; 0.37–0.71). Conclusions: Antibiotics were prescribed in 1 out of 4 febrile children whose parents contacted the out-of-hours service. Items associated with antibiotic prescription provide insight into the family physicians’ decision-making process when assessing children with fever. These can be used as targets for strategies to diminish antibiotic prescription. (J Am Board Fam Med 2012;25:810–818.)