Parental knowledge, antibiotic-seeking behavior, and inappropriate antibiotic use in children with respiratory tract infections: a narrative review of behavioral drivers and implications for antimicrobial resistance.

Authors

Himat Hussein Mamand, Saya Aziz Hama, Handren Wahid Murad, Ako Omer Ahmed

Published in

Infection. Nov 02, 2026. Epub Nov 02, 2026.

Abstract

Inappropriate antibiotic use is one of the main modifiable drivers of antimicrobial resistance (AMR). Children with respiratory tract infections receive a large share of avoidable prescriptions, and the reasons lie as much in behavior, communication, and access as in clinical need.
To synthesize evidence on the clinical, prescriber-related, parental, communication-related, access-related, and socioeconomic drivers of inappropriate antibiotic use in children with respiratory tract infections, and to appraise the evidence for interventions that target these drivers.
We conducted a narrative review guided by the SANRA criteria. PubMed/MEDLINE, Scopus, and Web of Science, supplemented by Google Scholar, were searched for English-language peer-reviewed studies published between January 2014 and December 2025. Thirty studies formed the core thematic synthesis. A supplementary search identified trials and reviews used to appraise stewardship interventions.
In countries like Italy and Finland, there was a significant decrease in pediatric prescriptions for uncomplicated respiratory infections, despite not being any increase in the occurrence of serious complications. Similarly, studies on acute otitis media indicated low benefits but abundant side effects. Although the parents were often misinformed about this process, knowledge alone was not sufficient to guarantee proper practice. Numerous studies revealed that physicians estimated the parents' needs incorrectly, and numerous children ended up receiving antibiotics that were not even asked for by their parents. One of the reasons for this issue was that patients were purchasing non-prescription medications, using leftover antibiotics, and limiting their access to affordable medical care. Research showed that communication, auditing, and clinical decision support training helped in reducing antibiotic prescriptions, while national training programs were not able to provide similar successes.
The inappropriate utilization of antibiotics among children is a result of influences from different levels: household, consultations, pharmacy and health system levels. These factors should be treated as associations instead of identified causes due to the fact that the majority of the evidence provided is cross-sectional. There is some evidence suggesting that a combination of clinician-targeted strategies with dispensing and access for medications is more promising than just education alone.

PMID:
42970227
Bibliographic data and abstract were imported from PubMed on 03 Nov 2026.

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