Antibiotics are the most common prescription drugs given to children, 75% percent of which are for acute respiratory tract infections (ARTIs). Since antibiotic prescribing is linked with antibiotic resistance, an ongoing effort is taking place to reduce prescribing and use of these medications. Although a decline in antibiotic prescribing for ARTIs has been recently documented in the US and UK, prescription of broad instead of narrow spectrum antibiotics is a major problem.

A survey examining European primary care paediatricians’ knowledge attitude and practice regarding ARTIs and antibiotics will be presented. The study pointed at a need for an educational intervention based on the risk-benefit analysis associated with the antibiotic prescribing for minor URIs, to reduce inappropriate prescribing.

Several strategies aimed either at clinicians to reduce prescribing or at caregivers to reduce antibiotic use will be presented. Multi-faceted approaches aimed at clinicians and parents have proven most effective in reducing prescribing. The effectiveness increased if structuring the clinician-parent interaction during the visit took place, and when computerised automatic prescribing prompts were used. The use of waiting room material was ineffective. Use of antibiotics by caregivers was reduced when delayed prescriptions were given.

Report from an antibiotic stewardship program in the US has recently been published. A one year program of personalised quarterly audit and feedback on prescribing through the computerised health record system succeeded to reduce broad spectrum antibiotic prescribing for ARTIs.