Antibiotic prescription for children with acute respiratory tract infections in rural primary healthcare in Guangdong province, China: a cross-sectional study

OBJECTIVES: The objective of this study is to understand the characteristics and patterns of the first antibiotic prescriptions for children with acute respiratory infections (ARIs) in rural primary healthcare (PHC) in Guangdong province, China. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: We used prescription data generated from the electronic medical record system of 37 township hospitals in two counties of Shaoguan City, Guangdong province. 46 699 first prescriptions for ARIs in children aged 0–18 years were screened from 444 979 outpatient prescriptions recorded between November 2017 and October 2018. OUTCOME MEASURES: Descriptive analyses were used to report sociodemographic characteristics and antibiotic prescribing profiles. χ(2) analysis and binary logistic regression were used to analyse the factors associated with antibiotic prescriptions in children. RESULTS: Of the 46 699 sampled cases, 83.00% (n=38 759) received at least one antibiotic as part of their first prescription. Of the 38 759 sampled cases treated with antibiotics, 40.76% (n=15 799), 56.15% (n=21 762) and 31.59% (n=12 244) received parenteral antibiotics, broad-spectrum antibiotics and two or more kinds of antibiotics, respectively. Multivariable analysis showed that children aged ≤5 years were less likely to be prescribed with antibiotics than those aged 16–18 years (OR 0.545, p<0.001). Those with health insurance were more likely to be prescribed with antibiotics than those without health insurance (OR 1.677, p<0.001). CONCLUSIONS: Misuse and overuse of antibiotics were found in the prescriptions of children with ARIs in rural PHC. Antibiotic stewardship programme should be established to reduce the level of antibiotic prescriptions among children with ARIs in rural PHC, especially regarding the prescriptions of broad-spectrum antibiotics and parenteral antibiotics, tailored to different ages, sex and health insurance groups.