Antibiotics for children in Latvia are used cautiously, but not always appropriately
Rapid diagnostics and targeted medical education can help reduce inappropriate antibiotic use even more effectively. The author of the study Prescribing patterns of antibacterial therapy for children with acute infections in primary care in Latvia and the impact of multifactorial interventions on antibacterial prescribing, Zane Līkopa, emphasises: “In primary care, decisions often have to be made immediately, and without diagnostic tools there is a risk of prescribing antibiotics ‘just to be on the safe side’.”
Why is this topic important for every family?
In her daily work in the Emergency Department at the Children’s Clinical University Hospital, Zane Līkopa often encounters antibacterial therapy that was started without sufficient justification. It was precisely this experience that prompted her to focus on primary care – the point at which the first and often decisive decisions are made.
“In hospital, we have broader diagnostic options. I wanted to understand how to help doctors earlier – already in the GP’s surgery,” the researcher explains.
Antibiotics are one of the most important achievements of medicine, but their excessive and inappropriate use promotes antimicrobial resistance – a situation in which bacteria become insensitive to treatment. This is a global public health challenge, and Latvia is no exception.
Children are a particularly sensitive group in this context. At pre-school age, most acute illnesses are caused by viruses and resolve on their own, yet in practice antibiotics are still often prescribed in such cases. This is why it is essential to understand how GPs decide to start antibacterial therapy and whether these prescribing habits can be changed.
A two-stage study in GP practices: education plus CRP testing at the point of care
The doctoral thesis analysed data from 80 GP practices in different regions of Latvia. The study took place in two stages, comparing routine practice with a situation in which doctors received a multifactorial intervention – educational seminars and the opportunity to use a rapid C-reactive protein (CRP) test at the point of care. This test makes it possible to determine the level of inflammation in the body during the consultation itself using a small capillary blood sample. It is particularly suitable for children and can help distinguish between viral and bacterial infections, which often look similar clinically.
29% of children receive antibiotics, often in cases of viral infections
The study data show that 29% of children received antibiotics, which is a relatively low rate in an international context. However, problematic trends were also identified – antibacterial therapy was often prescribed in cases of rhinopharyngitis or bronchitis, where viral infections predominate, and often already in the first days of illness.
About one third of the antibiotics prescribed were broad-spectrum agents, which do not comply with guidelines and may contribute to the development of resistance in the long term.
Do education and tests change physicians’ habits?
Interestingly, the intervention did not reduce the overall frequency of antibiotic prescribing to a statistically significant extent. One reason is the already relatively cautious use of antibiotics at baseline, as well as the possible lack of clear guidance on interpreting CRP tests in children. However, several positive changes were observed. For example, doctors used the delayed prescription approach more often, whereby the doctor issues an antibiotic prescription but agrees with the child’s parents that the medicine should not be started immediately, only if previously agreed conditions are met. Likewise, GPs’ decisions were less often based solely on clinical assessment, and the use of diagnostic tests increased significantly in regional GP practices. This indicates that rapid diagnostics can be an important support tool in daily work, especially in regions with limited access to laboratory testing.
Zane Līkopa’s research highlights that individual prescribing habits and professional experience significantly influence antibiotic prescribing. For more experienced doctors, change may be harder to implement, which is why targeted, personalised professional development and feedback on practice data are particularly important. At the same time, the study underlines the need to improve guidance for children, especially regarding the use of point-of-care CRP testing. “Only by combining education, diagnostics and clear recommendations can lasting change be achieved,” Z. Līkopa is convinced.
A summary of Līkopa’s doctoral thesis is available in the RSU e-resources repository.
