Educational interventions to reduce antibiotic prescribing for children with respiratory tract infections in primary care: A systematic review

Antibiotic resistance is a serious public health threat that is driven by overuse of antibiotics. The latter may occur in the management of children with mild self-limiting respiratory tract infections. Educational interventions to tackle the issue of antibiotic overuse targeted at parents and clinicians may help reduce unnecessary antibiotic use for respiratory tract infections. This systematic review sought to assess the effectiveness of educational interventions targeted at parents and clinicians in reducing antibiotic prescribing for children with respiratory tract infections in primary care settings.
A literature search was conducted in Medline, Cochrane Library, APA PsycInfo, and CINAHL for relevant published studies between 2000-2024. Inclusion criteria included studies of educational interventions for parents and/or clinicians, with regards to the management of respiratory tract infections in children under 18 years of age, in primary care settings. The risk of bias in RCTs was assessed utilizing the RoB 2 tool, whereas non-RCTs, before-and-after studies, and studies with historical controls were evaluated utilizing the ROBINS-I tool. A narrative synthesis was used to synthesize findings, and different techniques such as grouping, tabulation, textual descriptions of studies, and transforming data into a common rubric were utilized.
A total of 293 studies were identified, and 16 studies met the eligibility criteria. Two studies targeted only parents, five only clinicians, and nine both parents and clinicians. Overall, included studies were of low quality. Contradictory results were observed among studies investigating parent educational interventions, whereas some evidence of positive impact was identified among studies exploring educational interventions targeted at clinicians, and combined parent-clinician interventions.
There was insufficient evidence to provide a firm conclusion about the effectiveness of parent, clinician, and combined educational interventions. Additionally, the quality of evidence was not strong. Therefore, further high-quality research is recommended.