Primary healthcare practitioners' diagnostic and antibiotic prescribing decisions in children's consultations for respiratory tract infections

Children aged <12 years have 4–11 acute respiratory tract infections (RTIs) per year1 and this infection is the commonest reason why parents consult primary care in the UK.2 Consultations for RTIs are more complex than most guidelines assume, requiring primary care doctors and nurses (from here on ‘healthcare professionals’, HCPs) to manage clinical uncertainty regarding diagnosis, prognosis, and treatment.3 Although antibiotics have only marginal beneficial effects on RTIs, they remain frequently prescribed, contributing to illness medicalisation and antibiotic resistance. Antibiotic prescribing rates in the UK declined during the late 1990s but then rates levelled off and began to increase again in the early 2010s. Previous qualitative research examining the influences of antibiotic prescribing for children with acute illness has focused on unnecessary prescribing, giving less attention to clinical factors.9 It has been reported that clinicians may prescribe ‘just in case’ when they were uncertain about the clinical or social outcomes of not prescribing and were more likely to prescribe if they perceived pressure from parents.9 Parents, however, are primarily seeking a medical evaluation and many have a no treatment preference.9–11 Clinicians can be mistaken in the perception of parent pressure and this can sometimes lead to unwanted and unnecessary antibiotic prescribing. Diagnostic complexity and prognostic uncertainty play a key role in antibiotic prescribing decisions for adults, and some prescribing practices are not well supported by the existing evidence base. However, there is a need to understand how HCPs decide to prescribe antibiotics for children with acute RTIs, taking into account both clinical and non-clinical influences. This study examined how HCPs make diagnostic and antibiotic prescribing decisions in consultations for children with RTIs.