Previous studies demonstrate inconsistency in the use of diagnostic and therapeutic resources, including antibiotics, for children with febrile acute respiratory tract infection (ARTI).While antibiotic prescribing represents a modifiable behavior, most research has focused on the over-prescribing of antibiotics.

For a study published in The American Journal of Emergency Medicine, Aaron E. Kornblith, MD and colleagues sought to determine what factors lead to under-prescribing antibiotics in children presenting to EDs with symptoms of ARTI, specifically those with pneumonia. Patients were categorized into those diagnosed with bacterial pneumonia, respiratory tract infection requiring antibiotics, respiratory tract infection not requiring antibiotics, and other conditions.

Among nearly 6,500 visits, 10.2% had a final diagnosis of pneumonia, with 86% receiving antibiotics. Less than half of patients were diagnosed with an ARTI requiring antibiotics, of whom about 54% received antibiotics. More than one-fourth were diagnosed with ARTI not requiring antibiotics, among whom 36% received antibiotics. African-American race was a predictor for the underuse of antibiotics in ARTIs that required antibiotics.

“Our report highlights a need for future research including racial disparities in the treatment of a common pediatric complaint like acute respiratory tract infection,” says Dr. Kornblith. “Physicians should be aware of their own implicit bias when considering diagnostic evaluations and treatment plans for their pediatric patients.”

Dr. Kornblith adds that physicians should be aware that many factors may influence their decision to prescribe antibiotics in children with ARTI. “As medical professionals, it is our role to help inform and design interventions to address and eliminate inequities in the evaluation and treatment of children in the ED, including but not limited to that of appropriate antibiotic use,” says Dr. Kornblith.