The pattern of antibiotic administration for toddlers and infants with acute respiratory infections (Mashhad- Iran)

Document Type : Original Article


1 Mashhad University of Medical Sciences, Department of pediatric.

2 DEpartment of community medicine, Mashhad University of Medical Sciences

3 Mashhad University of Medical Sciences, school of hygiene

4 2Mashhad University of Medical Sciences, Department of Community Medicine


Acute respiratory infections (ARI) are the main cause for antibiotic (AB) use in all age groups specially the first two years of life. The local information about the pattern of AB prescription in ARI is a necessary part for any program which aims logical use of AB. The current study was designed to find the frequency and types of AB administration for ARI in young children (<2years) in Mashhad, Iran.
Method: This is an observational cohort study which was started in November 2005 and ended up at May 2006. The study group was composed of 1000 infants between 6 month and 20 months old. The children were followed monthly by telephone calls (up to six month after the first interview) and were asked about signs and symptoms of acute respiratory infection and systemic antibiotic use during each month.
The average monthly incidence of ARI was 34.5% in the study population, 66.3 %( mean) of the children with ARI were visited by a doctor, which led to AB prescription in 32.7 %( mean) of times. The frequency of inject able antibiotics was almost two times of oral Abs, and benzatin penicillin was the most prescribed AB (54%of all Abs).
The rate of AB administration for infants with ARI is not very high in Mashad, but the frequency of AB injections is unacceptable.


  1. Sasan MS, Zanian FR, Birjandi B, Naderinasab M, Ejtehadi MM. Extremely high prevalence of erythromycin resistance of group a Beta hemolytic streptococci in mashhad (iran). Iran J Pediatr. 2011;21(1):126-7
  2. Kusel MM1, de Klerk N, Holt PG, Landau LI, Sly PD. Occurrence and management of acute respiratory illnesses in early childhood. J Paediatr Child Health. 2007;43(3):139-46.
  3. el-Gilany AH. Acute respiratory infections in primary health care centres in northern Saudi Arabia. East Mediterr Health J. 2000;6(5-6):955-60.
  4. Nguyen QH1, Nguyen TK, Ho D, Larsson M, Eriksson B, Lundborg CS. Unnecessary antibiotic use for mild acute respiratory infections during 28-day follow-up of 823 children under five in rural Vietnam. Trans R Soc Trop Med Hyg. 2011;105(11):628-36.
  5. Ochoa C, Inglada L, Eiros JM, Solís G, Vallano A, Guerra L, et  al. Appropriateness of antibiotic prescriptions in community-acquired acute pediatric respiratory infections in Spanish emergency rooms. Pediatr Infect Dis J. 2001; 20(8): 751-8.
  6.  Qazi SA,  Rehman GN,  Khan MA. Standard management of acute respiratory infections in a children's hospital in Pakistan: impact on antibiotic use and case fatality. Bull World Health Organ. 1996; 74(5): 501–7.
  7. Lieberthal AS1, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-99.
  8. Chow AW1, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Infect Dis. 2012; 54(8): e72-e112.
  9. 10.  Meropol SB,  Chen Z,  Metlay JP. Reduced antibiotic prescribing for acute respiratory infections in adults and children. Br J Gen Pract. 2009; 59(567): e321–e8.

2.     Bakhsaee M, Ghazvini K, Naderi H, Zamanian A, Haghighi Z, Bagharabadi M. The Prevalencce of Nasopharyngeal Streptococcal Pneumonia Carriers in Mashad day care Children and their Antibiotic Resistance Pattern. The Iranian Journal of Otorhinolaryngology.2006; 18(45): 119-26.

11. Steinman MA1, Gonzales R, Linder JA, Landefeld CS. Changing use of antibiotics in community-based outpatient practice, 1991-1999. Ann Intern Med. 2003;138(7):525-33.

12. Hazir T, Nisar YB, Abbasi S, Ashraf YP, Khurshid J, Tariq P, et al. Comparison of oral amoxicillin with placebo for the treatment of world health organization-defined nonsevere pneumonia in children aged 2-59 months: a multicenter, double-blind, randomized, placebo-controlled trial in pakistan. Clin Infect Dis. 2011;52(3):293-300.