Predictors of Antibiotic Overuse in Pediatric Upper Respiratory Tract Infections: A Review

Abstract

Antibiotic overuse in pediatric upper respiratory tract infections (URTIs) is a persistent antimicrobial-stewardship problem. Most pediatric URTIs are viral and self-limiting, yet antibiotics continue to be prescribed when bacterial infection is unconfirmed or when clinical criteria for treatment are not met. This narrative review synthesizes evidence on the prevalence of inappropriate antibiotic use, predictors of prescribing, clinical syndromes commonly associated with overuse, consequences, and strategies for reduction. Available studies indicate that prescribing is influenced by both clinical and behavioral factors, including diagnostic uncertainty, parental expectations, physician characteristics, workload, access to diagnostic testing, local prescribing culture, and the strength of stewardship infrastructure. In a prospective multicentre study, 37% of children with adjudicated viral respiratory tract infection received antibiotics. In a Saudi Arabian study of children and other patients with URTI symptoms, 30.1% received antibiotics; prescribing was higher in the pediatric emergency department than in primary healthcare centres. Recent evidence also suggests that prescribing varies by care modality, with lower antibiotic prescribing during primary-care telemedicine visits than during in-person visits. Reducing overuse requires a multifaceted approach combining evidence-based guidelines, diagnostic stewardship, communication with caregivers, audit and feedback, and organizational commitment to antimicrobial stewardship. The goal is not simply to reduce antibiotic volume, but to ensure that every prescription has a clear clinical indication, uses an appropriate agent, dose, and duration, and minimizes avoidable harm.