Table 3 Risk factors of antibiotic utilization in children in China.
From: Prevalence and risk factors for antibiotic utilization in Chinese children
| Â | Risk factors | Â | No. of studies (N=42) |
|---|---|---|---|
Children | distribution of disease | The biological systems and organs of children are not well-developed, especially those of younger children, which make children more vulnerable. Children with upper respiratory tract infections (URTIs) are among the highest receivers of antibiotics. | 3 (7.1%) |
| Â | lack of skills and knowledge | Middle school students still have problems in medication adherence, the management of expired drugs and the antibiotics cognition. | 1 (2.4%) |
Physicians | lack of skills and knowledge | Physicians consider antibiotics to be anti-inflammatory drugs is a common misconception. Doctors might overprescribe antibiotics due to lack of knowledge of its rational use. Gaps between reported knowledge and actual practice within antibiotic prescribing are commonly encountered. | 19 (45.2%) |
| Â | pressure from patient | Majority of the village doctors would prescribe antibiotics if their patients stick to getting them. | 5 (11.9%) |
| Â | physician-patient relationship | Ineffective communication between patients and physicians may lead to the unnecessary prescription of antibiotics. | 2 (4.8%) |
|  | economic incentive and profit from prescribing medicine | Retention of patients would increase physicians’ consultation fees. Doctors are able to make a profit from individual drug prescriptions, including antibiotics, and this may stimulate over-prescribing of antibiotics. | 5 (11.9%) |
| Â | lack of pathogen detection or low pathogen detection rate | Uncertainty in the etiological diagnosis is reported as one of the main causes of fear when prescribing in primary care settings. The doctor paid little attention to microbiological examination. | 8 (19.0%) |
Caregivers | lack of skills and knowledge | Parents have considerable misunderstandings that may contribute to inappropriate antibiotic use. Most of parents believe that taking antibiotics in advance could protect children from common diseases. | 28 (66.6%) |
|  | put pressure on physician to get antibiotics | Parents’ high expectations of quick relief of symptoms and recovery of their children would impose further pressure on doctors to prescribe antibiotic in order to make treatments more immediately effective. | 14 (33.3%) |
| Â | self-medicating with antibiotics at home for children | Most of the parents would use lower dose of antibiotics than required by the instruction with consideration of safety, and some parents would choose a higher dose. | 14 (33.3%) |
Retail pharmacies | sale antibiotics without prescription | Although antibiotics sales in retail pharmacies are not within the jurisdiction of government regulation, retail pharmacy is still the main channel for parents to purchase antibiotics. | 11 (26.2%) |
Hospitals | ward capacity | Newborn units with more than 100 beds have the highest rate of antibiotic use, compared to units with 50 or fewer beds, and those with 51–100 beds. | 1 (2.4%) |