Recommendations for antibiotic prescriptions for upper respiratory symptoms in children in Trinidad and Tobago: GRADE-ADOLOPMENT APPROACH

Background: In Trinidad and Tobago, 22,329 and 18,594 cases of acute respiratory infections (ARI) in children less than 5 years were recorded for 2016 and 2017 respectively. Often, antimicrobials are over prescribed without proof of bacterial infection. Recommendations for management of ARIs are needed. Methods: The GRADE-ADOLOPMENT approach was used to formulate recommendations. We established a guideline panel who met in person or by web conferences. We prioritised recommendation questions and searched for guidelines and systematic reviews from 2010 to July 2018 in several medical databases and guideline producer websites. We also searched for patients’ values and preferences, acceptability, resources, and feasibility studies specific to the Caribbean or Trinidad and Tobago. We summarised the evidence in evidence-to-decision frameworks and formulated recommendations by consensus. Results: The guideline panel developed recommendations including: 1. For children 5 years old or younger who present with fever and respiratory symptoms not suggestive of serious illness, we recommend to either not prescribe antibiotics or to provide a delayed prescription (48 hours later) of amoxicillin or clarithromycin (when children have a history of allergy to penicillin) rather than an immediate prescription; 2. For children with symptoms suggestive of serious illness, we recommend immediate prescription of amoxicillin or clarithromycin (when children have a history of allergy to penicillin); and, 3. We suggest 7-10 days of treatment, depending on the suspected illness and antibiotic used. Conclusion: Guidelines aid medical practitioners, patients and supply chain managers. This guideline will form the backbone of the 1st national standardisation of treatment using the GRADE-ADOLOPMENT approach.