SynthesisArchives of disease in childhood2022
Antibiotic use in ambulatory care for acutely ill children in high-income countries: a systematic review and meta-analysis.
Synthesis in Archives of disease in childhood, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 6 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Pooled it
- Antibiofilm Effects of Novel Compounds in Otitis Media Treatment: Systematic Review.International journal of molecular sciences · 2024Pooled it
- Antimicrobial prescription pattern and appropriateness for respiratory tract infection in outpatients: a systematic review and meta-analysis.Systematic reviews · 2024Pooled it
- Factors associated with inappropriateness of antibiotic prescriptions for acutely ill children presenting to ambulatory care in high-income countries: a systematic review and meta-analysis.The Journal of antimicrobial chemotherapy · 2024Pooled it
- The effect of antibiotics on the intestinal microbiota in children - a systematic review.Frontiers in allergy · 2024Pooled it
- Antibiotics for acute otitis media in children.The Cochrane database of systematic reviews · 2023Pooled it
- Improved diagnostic management of children with acute infections following the introduction of point-of-care C-reactive protein testing and general practitioner education in Latvia: aScandinavian journal of primary health care · 2026Trial
- Parenteral Vaccine-Induced Antibody Levels in Children with Heavy Antibiotic Exposure in Dhaka, Bangladesh.The American journal of tropical medicine and hygiene · 2026Trial
- Homeopathic Medicines for the Treatment of Acute Otitis Media: a Real-World Cohort Study on Recurrences and Antibiotic Prescriptions Compared to those with Conventional Treatments.Homeopathy : the journal of the Faculty of Homeopathy · 2026Article
- Lung ultrasound combined with C-reactive protein for identifying a bacterial component in children hospitalized with acute lower respiratory tract infections: a prospective observational study.European journal of pediatrics · 2026Observational
- A survey of parental health-seeking behaviour, knowledge, and expectations around ear infection symptoms in children.BJGP open · 2026Article
- Determinants of expert-advised antibiotic indication in pediatric emergency department, data from a cross-sectional prevalence survey.BMC pediatrics · 2026Article
- Changes in the Dispensing of Antibiotics to Australian Children Between 2013 and 2023: Are We Heading in the Right Direction?Paediatric and perinatal epidemiology · 2026Observational
- Epidemiological characteristics of six common respiratory pathogen infections in children.Microbiology spectrum · 2025Article
- Safety netting advice for acutely ill children presenting to ambulatory care: exploring parents' opinions, ideas, and expectations through focus group interviews.BMC primary care · 2025Article
- Impact of COVID-19 on Antimicrobial Stewardship Activities in Hospitalised Children: A Scoping Review.Journal of paediatrics and child health · 2025Article
- Behavioural impact of antibiotic stewardship in children in primary care: interviews with GPs and parents.JAC-antimicrobial resistance · 2024Article
- Implementation of a Multifaceted Program to Improve the Rational Use of Antibiotics in Children under 3 Years of Age in Primary Care.Antibiotics (Basel, Switzerland) · 2024Article
- The impact of probiotics and vitamin C on the prevention of upper respiratory tract symptoms in two preschool children cohorts.Nutrition research and practice · 2024Article
- The role of antibiotic exposure and the effects of breastmilk and human milk feeding on the developing infant gut microbiome.Frontiers in public health · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 6 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine the rate and appropriateness of antibiotic prescribing for acutely ill children in ambulatory care in high-income countries.
designOn 10 February 2021, we systematically searched articles published since 2000 in MEDLINE, Embase, CENTRAL, Web Of Science and grey literature databases. We included cross-sectional and longitudinal studies, time-series analyses, randomised controlled trials and non-randomised studies of interventions with acutely ill children up to and including 12 years of age in ambulatory care settings in high-income countries. Pooled antibiotic prescribing and appropriateness rates were calculated using random-effects models. Meta-regression was performed to describe the relationship between the antibiotic prescribing rate and study-level covariates.
resultsWe included 86 studies comprising 11 114 863 children. We found a pooled antibiotic prescribing rate of 45.4% (95% CI 38.2% to 52.8%) for all acutely ill children, and 85.6% (95% CI 73.3% to 92.9%) for acute otitis media, 37.4% (95% CI 30.9% to 44.3%) for respiratory tract infections, and 40.4% (95% CI 29.9% to 51.9%) for other diagnoses. Considerable heterogeneity can only partly be explained by differences in diagnoses. The overall pooled appropriateness rate is 68.5% (95% CI 55.8% to 78.9%, I²=99.8%; 19 studies, 119 995 participants). 38.3% of all prescribed antibiotics were aminopenicillins.
conclusionsAntibiotic prescribing rates for acutely ill children in ambulatory care in high-income countries remain high. Large differences in prescription rates between studies can only partly be explained by differences in diagnoses. Better registration and further research are needed to investigate patient-level data on diagnosis and appropriateness.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.