Antimicrobial drugs are prescribed almost twice as often as expected to pediatric outpatients presenting with acute respiratory tract infections (ARTI) in the U.S., according to a Pediatrics study.

In a meta-analysis, researchers examined studies assessing the bacterial etiologies of ARTIs in children after the licensure of the pneumococcal conjugate vaccine in 2000. Bacteria were isolated in 65% of acute otitis media visits and 20% of pharyngitis visits. The overall estimated bacteria prevalence — and thus expected antimicrobial prescribing rate — for all ARTIs combined was 27%. However, a retrospective cohort analysis of children in ambulatory clinics found that antimicrobials were prescribed in 57% of ARTI visits.

The authors estimate that there are 11.4 million potentially avoidable prescriptions for antibiotics every year for ARTIs and conclude that this area represents "an important target for ongoing antimicrobial stewardship interventions."