Age
Girls (n = 48)
Boys (n = 43)
n (%)
n (%)
≤Q25 %
10
20.8
13
30.2
≤Q50 %
15
31.2
9
20.9
≤Q75 %
10
20.8
11
25.6
>Q75 %
13
27.1
10
23.3
The selected primary healthcare establishment was staffed by three full-time pediatricians and characterized by a high staff turnover, i.e., many different physicians worked in the establishment during the period analyzed. Then we drew two letters from the alphabet and selected children with a family name beginning with those letters. Only children cared for from birth were included. Most patients were born in 2008 (20/91, 21.9 %). We analyzed the number of visits due to respiratory tract infections, the mean age at which the first infection occurred, and the type of infections. The number of infections treated with antibiotics was also assessed.
Categorical variables were reported as frequencies (%). Qualitative data were not normally distributed, which was confirmed by the Shapiro-Wilk test, and were presented as median, minimum–maximum (min–max), and interquartile range (IQR). Differences in the qualitative variables between groups was verified by the Wilcoxon rank-sum test or the Kruskall-Wallis rank-sum test. Independence of categorical variables was confirmed by the Fisher exact test. The Spearman rank correlation test was used to check correlations between the variables. The level of statistical significance was set at p < 0.05. The R 2.10.1 (for Mac OS X Cocoa GUI) statistical software was used for all data analyses.
3 Results
The median number of all visits was 32 (min–max 5–136, IQR 30). The median of the annual indicator of total visits (number of visits divided by child’s age at the study end) was 8.3 per year (min–max 2.1–29.8, IQR 5.5). The median of all visits due to respiratory tract infections was 13 (min–max 1–77, IQR 15.5), with the median of the annual indicator being 2.6 per year (min–max 0.15–11.9, IQR 3.4). The median of visits due to URTI was 8 (min–max 1–33, IQR 9.5), with the median of the annual indicator being 1.8 per year (min–max 0.2–6.0, IQR 1.8).
The distribution of visits due to URTIs in the first 3 years of life was similar and not related to gender (W = 919, p = 0.371). The median of visits due to URTIs was 2.0 per year (min–max 0.0–9.0, IQR 2.0) in the first year of life, 2.0 per year (min–max 0.0–8.0, IQR 3.0) in the second year of life and 2.0 per year (min–max 0.0–11.0, IQR 4.0) in the third year of life. The medians did not differ significantly (Kruskal-Wallis chi2 = 1.4456, df = 2, p = 0.485).
The median of the age at which the first respiratory infection occurred was 0.4 years (min–max 0.0–4.6, IQR 0.6), while the median of the first antibiotic treatment was 0.7 years (min–max 0.1–4.6, IQR 0.7). The vast majority of children, 84.6 % (77/91), were treated with antibiotics and the first antibiotic was prescribed due to a respiratory tract infection in most of them 60/91 (65.9 %).
The majority (57.4 %) of respiratory tract infection episodes were treated with antibiotics. The most common non-specific URTIs were treated with antibiotics in 25.8 % of cases. Antibiotics were prescribed in 90.7 % cases of acute tonsillitis, 67.5 % of bronchitis, 65.9 % of otitis media, 60.9 % of pneumonia, 22.2 % of laryngitis, and 12.5 % of sinusitis (Table 2). The annual antibiotic therapy indicators (number of antibiotic therapies due to a given diagnosis divided by child’s age at the study end) was highest in acute tonsillitis (median 0.38) as presented in Table 3.
Table 2
Frequency of antibiotic therapy
Diagnosis | Therapy | |||
|---|---|---|---|---|
Antibiotics | No antibiotics | |||
n (%) | n (%) | |||
Non-specific URTI | 206 | 25.8 | 594 | 74.2 |
Acute tonsillitis | 39 | 90.7 | 4 | 9.3 |
Otitis media | 56 | 65.9 | 29 | 34.1 |
Bronchitis | 79 | 67.5 | 38 | 32.5 |
Sinusitis | 1 | 12.5 | 7 | 87.5 |
Laryngitis | 4 | 22.2 | 14 | 77.8 |
Pneumonia | 14 | 60.9 | 9 | 39.1 |
Table 3
Annual indicators of therapy with antibiotics
Annual indicators of antibiotic therapya | Median | Min–max | IQR |
|---|---|---|---|
Acute tonsillitis | 0.38 | 0.00–1.73 | 0.61 |
Otitis media | 0.00 | 0.00–0.72 | 0.03 |
Bronchitis | 0.00 | 0.00–1.00 | 0.17 |
Sinusitis | 0.00 | 0.00–1.24 | 0.20 |
Laryngitis | 0.00 | 0.00–0.51 | 0.00 |
Pneumonia | 0.00 | 0.00–0.69 | 0.00 |
The median of the annual antibiotic therapy indicators (number of antibiotic therapies divided by child’s age at the study end) was 0.8 per year (min–max 0.0–3.9, IQR 1.2). The median of the annual antibiotic therapy indicators due to URTI (number of antibiotic therapies due to URTI divided by child’s age at the study end) was 0.6 per year (min–max 0.0–3.1, IQR 1.0). Acute tonsillitis was the respiratory infection most commonly treated with antibiotics (Kruskal-Wallis chi2 = 170.3527, df = 6, p < 0.0001). Children treated with antibiotics due to URTI had significantly higher annual indicators for visits due to URTI (W = 720.5, p = 0.046).
3.1 Significant Correlations
The annual indicator of the total number of visits correlated with the number of visits due to URTIs (r = 0.71, p < 0.0001) – the higher the number of visits due to URTI, the higher was the number of visits to the primary care establishment. Interestingly, the annual indicator of the total number of antibiotic therapies was associated with the annual indicator of the total number of visits (r = 0.57, p < 0.0001) – more often use of antibiotics was reflected in more visits to the doctor. We also calculated that the annual antibiotic therapy indicator due to URTI correlated with the annual indictor for the total number of visits (r = 0.52, p < 0.0001) – more often antibiotic treatment was prescribed due to URTI, the more often visits were made to the doctor. Administration of the first antibiotic in life due to a respiratory tract infection had no impact on the annual indicator for visits due to URTI (W = 386, p = 0.644).
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