A systematic review to explore influences on parental attitudes towards antibiotic prescribing in children

Aim: To understand the factors influencing parental attitudes towards antibiotic prescribing. Background: Overuse of antibiotics and inappropriate prescribing has resulted in rapid development of antimicrobial resistance (AMR), and is significant global threat to patient safety. In Primary Care settings, substantial numbers of antibiotics are prescribed for young children, despite viral nature of illness for which antibiotics are ineffective. Parents, play a vital role in decision making regarding accessing healthcare services and requesting treatment for their children. Design: A systematic review was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (Moher et al 2015). Methods. The CINAHL, MEDLINE, PsycINFO, The Cochrane Library, BRITISH NURSING INDEX, EMBASE and PUBMED databases were searched for primary research published between 2006-16. All types of primary research were searched and screened against inclusion criteria. The Critical Appraisal Skills Programme tool was used to appraise identified publications. Quantitative data was summarised descriptively and qualitative data was thematically analysed. Results: A total of 515 publications were initially screened, and 55 full-text articles were eligibility assessed. Twenty papers met inclusion criteria. Four main themes were identified: the quality of relationships with health care providers, dealing with conflicting messages, rationalising antibiotic use and parental practices informed by past experience. Conclusion: Parents wanted reassurance and advice regarding children's illnesses, had poor antibiotic knowledge and were influenced by personal past experiences. More accessible education, including simple information leaflets, is required. Further research on the influence of culture, ethnicity and socio- economic factors would be beneficial. Relevance to clinical practice: Health care professionals must provide adequate time for reassurance and explanations of decision making. Easy to read information regarding appropriate antibiotic usage should be easily accessible for parents