Assessment of physicians’ proficiency concerning antibiotic use for upper respiratory tract infections in children: a cross-sectional study

Since most upper respiratory tract infections (URTIs) are caused by viruses, treatment with antibiotics is considered nonbeneficial and futile. Nonetheless, antibiotic misuse remains a concern that has a profound impact on global health, owing to the possible development of antibiotic resistance. Therefore, understanding the factors influencing physicians' practices and attitudes and assessing their level of knowledge regarding antibiotic prescriptions for children with URTIs is advisable to determine the factors that lead to the emergence of antibiotic resistance. A cross-sectional study was conducted among pediatricians and pediatric residents in the northern West Bank, Palestine, from December 2021 to the end of January 2022. Data were collected via a validated self-administered questionnaire with four sections: demographic details, knowledge (scored 0-1), attitudes (11-item Likert scale, maximum 55), and prescribing behavior for pediatric URTIs (scored 1-5, maximum 55). Statistical analysis was performed via SPSS v21, with nonparametric tests (Mann‒Whitney U, Kruskal‒Wallis) applied for nonnormal variables (p < 0.05). Demographics, knowledge, attitudes, and behaviors were summarized using frequencies, percentages, medians, and interquartile ranges. A total of 108 questionnaires were collected and returned, yielding a response rate of 90%. The overall level of knowledge among the respondents was commendable but concerning, as 22% of them mistakenly believed that antibiotics functioned as anti-inflammatory drugs. T The participants' attitudes ranged from 29 to 52 points, with a maximum possible score of 55. The average score was 41.1 ± 3.6, reflecting generally favorable attitudes toward antibiotic usage among the participants. However, 6.5% of the respondents expressed a preference for the use of broad-spectrum antibiotics for most cases of acute URTIs. The practice score also followed a normal distribution, with an average score of 35.4 ± 7.7 out of 55. Some respondents identified challenges in properly prescribing antibiotics, such as the time required to explain antibiotics to parents, parental requests for antibiotics, and uncertainty regarding the illness. The age of the respondents was significantly positively correlated with their behavioral state (p = 0.037), with older respondents exhibiting better behavioral patterns. Pediatric residents and female respondents had comparatively lower perceptions of antibiotic behavior and practices (p = 0.004 and p = 0.03, respectively). Additionally, the results revealed positive correlations between participants' attitudes and practices (rs = 0.434, p < 0.001) and between their knowledge and practices (rs = 0.355, p < 0.001). Several factors influencing physicians' practices, as well as factors related to parents, were identified. Thus, enhancing knowledge alone may not be sufficient. Possible recommendations were examined, with a focus on improving the doctor‒patient relationship and implementing essential educational interventions to increase awareness of antibiotic resistance and promote better prescribing and purchasing behaviors for both physicians and the general public.