Effectiveness of a parental educational intervention in reducing antibiotic use in children: a randomized controlled trial.

OBJECTIVE: To determine whether an educational intervention aimed at parents leads to fewer antibiotic prescriptions for their children. DESIGN: Placebo-controlled, randomized controlled trial. SETTING: Offices of primary care pediatricians who are members of a regional practice-based research network. PARTICIPANTS: Healthy children younger than 24 months old enrolled at the time of an office visit. INTERVENTIONS: Parents of study children were randomized to receive either a pamphlet and videotape (featuring one of their child's pediatricians) promoting the judicious use of antibiotics (intervention group) or brochures about injury prevention (control group). A total of 499 eligible children were enrolled, and data on outpatient visits during a 12-month observation period were collected. MAIN OUTCOME MEASURES: We compared the number of visits for upper respiratory tract infections (URIs), number of diagnoses and antibiotic prescriptions for otitis media and/or sinusitis and total number of antibiotics per patient among children in the intervention and control groups using Poisson regression analysis, adjusted for clustering into different practices. RESULTS: : Data on 4924 visits were reviewed; 28.8% of these visits were because of URI symptoms. The mean number of visits per study patient for URI symptoms was 2.8. Including all visits, the mean number of diagnoses of otitis media in study children was 2.1, mean number of diagnoses of otitis media and/or sinusitis was 2.3 and mean number of antibiotic prescriptions was 2.4; there were no significant differences between children in the intervention and control groups for any of these outcomes. Overall physicians prescribed 1 or more antibiotics during 45.9% of visits for a chief complaint of URI symptoms; 92% of antibiotic usage in children presenting with URI symptoms was for a diagnosis of otitis media and/or sinusitis. CONCLUSIONS: An educational intervention aimed at parents did not result in a decrease in the number of antibiotic prescriptions in their children. The use of antibiotics among children with URI symptoms was common; other interventions promoting the judicious use of these medications are needed.

Effectiveness of an educational intervention in modifying parental attitudes about antibiotic usage in children.

OBJECTIVE: To determine the effectiveness of educational materials in improving the attitudes of parents of young children about the judicious use of antibiotics. METHODS: We conducted a randomized controlled trial by recruiting parents of children who were younger than 24 months and being seen for any reason in primary care pediatric offices. At the time of enrollment, study parents indicated their level of agreement with 16 statements, including 9 statements about antibiotic usage and 7 about injury prevention. After being randomized, parents received either a pamphlet and a videotape promoting the judicious use of antibiotics (intervention group) or brochures about effective injury prevention (control group). Six weeks after enrollment, each group received another copy of the pamphlet or brochures and a follow-up questionnaire with the identical 16 statements. Responses on both questionnaires were transformed to an ordinal scale for analysis. Scores on the follow-up questionnaire for each statement about antibiotic use and injury prevention in the 2 groups were compared using linear regression, after controlling for the score obtained for the statement at enrollment. RESULTS: We enrolled a total of 499 eligible parents in the study; 358 (72%) completed the follow-up questionnaires. At study entry, there were no significant differences between parents in the intervention and control groups regarding attitudes for 15 of the 16 statements assessed. However, 6 weeks after receiving the antibiotic educational materials, parents in the intervention group had significantly different attitude scores for 5 of the 9 statements about the antibiotic use. In each case, the scores reflected attitudes that would promote the judicious use of antibiotics. We found significant attitudinal change for statements about the use of antibiotics for specific conditions in children; there were no differences between the 2 groups for more general or theoretical statements about antibiotic use. CONCLUSIONS: A simple educational effort was successful in modifying parental attitudes about the judicious use of antibiotics. Information about specific childhood conditions may be more effective in changing attitudes than more general information about antibiotic usage.