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<p>Pharyngitis is a major contributor to antibiotic overuse in paediatric primary care, thereby driving antimicrobial resistance. Distinguishing group A β-hemolytic streptococcus (GABHS) from non-specific pharyngitis is crucial, as it directly influences treatment decisions. Post-COVID-19 changes in infection patterns and prescribing baehaviours have been observed. This study investigates the epidemiology, management, and outcomes of paediatric pharyngitis using data from the Pedianet network. Episodes of pharyngitis occurring between January 2010 and September 2024 among children aged 0–14 years were included and classified as GABHS, and in a heterogeneour category named non-specific pharyngitis. Antibiotic prescriptions within 14 days after the diagnosis were considered. Descriptive statistics, incidence rates, prescription rates, and logistic models were used to describe these patterns and evaluate the association between antibiotic use and access to Emergency Room (ER) or hospitalization for any cause within 15 days after the diagnosis. Results from logistic regression analyses were reported as odds ratios (ORs) and 95% confidence intervals (95%CIs). A total of 567,705 episodes of pharyngitis were included (18.8% GABHS and 81.2% non-specific pharyngitis). Pharyngitis mainly affected preschool and school-age children (43.5% and 25.9% in those aged 2–&lt;6 and 6–&lt;11 years, respectively), whereas non-specific pharyngitis also involved children younger than two years (27.5%). Overall incidence rates declined over time, except for GABHS pharyngitis in the post-COVID-19 period (7.22 events per 100 person-years). Almost all GABHS pharyngitis cases were treated, while a portion of non-specific pharyngitis cases remained untreated. Amoxicillin was the most prescribed antibiotic, but during and post-COVID-19 pandemic, broader-spectrum antibiotics were used more frequently than in the pre-pandemic period. Treatment in children diagnosed with non-specific pharyngitis was associated with a 49% (OR=1.49, 95%CI:1.33–1.66) significantly higher risk of access to ER or hospitalization for all cause, while no association was found in GABHS pharyngitis (OR=0.91, 95%CI:0.69–1.21). The post-COVID-19 incidence peak of pharyngitis may reflect an immunity gap among children. Guideline-based antibiotic use remains essential to prevent complications and antimicrobial resistance,therby optimizing the management of pharyngitis.</p>

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Temporal trends in pediatric pharyngitis and antibiotic prescribing in Italian primary care from 2010 to 2024

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  • 发表日期：

    2026年7月23日

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  • Riccardo Boracchini,
  • Vera Rigamonti,
  • Giulia Brigadoi,
  • Federico Longari,
  • Carlo Giaquinto,
  • Anna Cantarutti,
  • Daniele Donà,
  • Luigi Cantarutti,
  • Fabiana Accardo,
  • Arturo Alberti,
  • Stefano Alboresi,
  • Katya Alessio,
  • Federica Alfani,
  • Eva Alfieri,
  • Sara Alfieri,
  • Michela Alfiero Bordigato,
  • Monica Aloe,
  • Anna Aloisio,
  • Angelo Alongi,
  • Domenico Amabile,
  • Flavia Amaro,
  • Denise Amato,
  • Elena Amodeo,
  • Biagio Amoroso,
  • Rosaria Ancarola,
  • Barbara Andreola,
  • Maria Luisa Andretta,
  • Giampaolo Anese,
  • Roberta Angelini,
  • Maria Grazia Apostolo,
  • Bruno Arcangeli,
  • Giovanna Argo,
  • Valentina Assirelli,
  • Giovanni Avarello,
  • Lucia Azzoni,
  • Marta Bacciarini,
  • Franco Balliana,
  • Maria Carolina Barbazza,
  • Maria Barberi Frandanisa,
  • Patrizia Barbieri,
  • Davide Bardella,
  • Roberto Barone,
  • Alice Bedini,
  • Donatella Bellavere,
  • Gabriele Belluzzi,
  • Eleonora Benetti,
  • Alessandra Beni,
  • Chiara Maria Beretta,
  • Fabio Berti,
  • Roberto Bezzi,
  • Filippo Biasci,
  • Claudio Biondi,
  • Giovanni Battista Biserni,
  • Franca Boe,
  • Ilaria Boiani,
  • Stefano Bollettini,
  • Francesco Bonaiuto,
  • Emanuela Bonfigli,
  • Anna Maria Bontempelli,
  • Matteo Bonza,
  • Gloria Borsari,
  • Elisa Bortoli,
  • Claudia Bortolin,
  • Giuseppe Boscarelli,
  • Lucia Boselli,
  • Sara Bozzetto,
  • Cecilia Bresci,
  • Rosa Britta,
  • Andrea Bruna,
  • Ivana Brusaterra,
  • Guido Brusoni,
  • Mariella Bruzzese,
  • Roberto Budassi,
  • Massimo Caccini,
  • Ilaria Cadel,
  • Mariaclaudia Caiulo,
  • Laura Calì,
  • Maria Grazia Cammarata,
  • Sonia Camposilvan,
  • Laura Cantalupi,
  • Luigia Caprio,
  • Simone Carbogno,
  • Chiara Cardarelli,
  • Giovanna Carli,
  • Sylvia Carnazza,
  • Rita Casalboni,
  • Anna Casani,
  • Massimo Castaldo,
  • Stefano Castelli,
  • Serenella Castronuovo,
  • Monica Cavedagni,
  • Maria Silvia Cavinato,
  • Cristina Cecamore,
  • Stefania Censini,
  • Giuseppe Egidio Cera,
  • Chiara Chillemi,
  • Rosa Maria Chiuri,
  • Simona Ciccarelli,
  • Francesca Cichello,
  • Giuseppe Cicione,
  • Niccolò Ciliani,
  • Anna Giulia Cimatti,
  • Anna Cingolani,
  • Carla Ciscato,
  • Mariangela Clerici Schoeller,
  • Samuele Cocchiola,
  • Eleonora Coclite,
  • Margherita Codifava,
  • Marta Cofini,
  • Maurizio Coletta,
  • Giuseppe Collacciani,
  • Enrico Coltraro,
  • Fabrizio Comaita,
  • Ugo Alfredo Conte,
  • Valeria Conte,
  • Matteo Corchia,
  • Francesca Corrias,
  • Roberta Corro’,
  • Rosaria Costagliola,
  • Nicola Costanzo,
  • Sandra Cozzani,
  • Giulia Cremonini,
  • Giancarlo Cuboni,
  • Giorgia Curia,
  • Valentino Curti,
  • Salvatore Curto,
  • Caterina D’alia,
  • Vito Francesco D’Amanti,
  • Michela D’Antoni,
  • Antonio D’Avino,
  • Alessandro D’Uva,
  • Chiara Dalla Casa,
  • Rita De Angelis,
  • Roberto De Clara,
  • Lorenzo De Giovanni,
  • Annamaria De Marchi,
  • Luisa De Marco,
  • Chiara De Mutiis,
  • Emanuele De Nicolò,
  • Nicoletta De Polo,
  • Irene Degrassi,
  • Gian Piero Del Bono,
  • Gigliola Del Ponte,
  • Chiara Delehaye,
  • Fabio Dell’Antonia,
  • Giovanna Di Corcia,
  • Tiziana Di Giampietro,
  • Simona Di Loreto,
  • Giuseppe Di Mauro,
  • Francesco Di Mauro,
  • Salvatore Di Palma,
  • Anna Paola Di Renzo,
  • Giuseppe Di Santo,
  • Piero Di Saverio,
  • Mattea Dieli,
  • Marco Dolci,
  • Mattia Doria,
  • Stefano Drago,
  • Dania El Mazloum,
  • Giuseppe Elio,
  • Maria Carmen Fadda,
  • Clara Maria Faedi,
  • Bernadette Faggioli,
  • Pietro Falco,
  • Elena Falcon,
  • Mario Fama,
  • Marco Faraci,
  • Maria Immacolata Farina,
  • Alessio Favali,
  • Tania Favilli,
  • Susanna Fedeli,
  • Mariagrazia Federico,
  • Michele Felice,
  • Maurizio Ferraiuolo,
  • Enrico Ferrara,
  • Marta Ferrarese,
  • Michele Ferretti,
  • Mauro Gabriele Ferretti,
  • Paolo Forcina,
  • Patrizia Foti,
  • Claudio Paolo Frattini,
  • Luisa Freo,
  • Ezio Frison,
  • Fabrizio Fusco,
  • Teresa Fusco,
  • Alessandra Gabutti,
  • Ambra Gagliardo,
  • Giovanni Gallo,
  • Roberto Gallo,
  • Andrea Galvagno,
  • Livia Garlisi,
  • Stefano Gastaldo,
  • Alberta Gentili,
  • Pierfrancesco Gentilucci,
  • Erica Giacomelli,
  • Giuliana Giampaolo,
  • Giuseppe Giancola,
  • Francesco Gianfredi,
  • Letizia Giaretta,
  • Eugenia Giraldi,
  • Silvia Girotto,
  • Isabella Giuseppin,
  • Laura Gnesi,
  • Costantino Gobbi,
  • Renza Granzon,
  • Mauro Grelloni,
  • Mirco Grugnetti,
  • Silvia Gulden,
  • Marwan Hamarneh,
  • Martina Ielo,
  • Giorgia Inchingolo,
  • Giulia Innocenzi,
  • Angela Cristina Intini,
  • Antonina Isca,
  • Urania Elisabetta Lagrasta,
  • Maurizio Lanci,
  • Massimo Landi,
  • Maura Lazzari,
  • Maria Rosaria Letta,
  • Francesca Levi Della Vida,
  • Giuseppe Lietti,
  • Marianna Ligas,
  • Cinzia Lista,
  • Giuseppe Lorusso,
  • Ricciardo Lucantonio,
  • Elide Lucchi,
  • Francesco Luise,
  • Diego Luotti,
  • Nadia Macropodio,
  • Ivan Maddaluno,
  • Matilde Maione,
  • Tommaso Malusa,
  • Elisabetta Manzali,
  • Enrico Marano,
  • Valeria Marchetti,
  • Benedetta Marchi,
  • Isabella Margherita,
  • Francesca Marine,
  • Lorenzo Mariniello,
  • Pietro Marino,
  • Gabriella Marostica,
  • Valentina Marzetti,
  • Sergio Masotti,
  • Maura Mastrocola,
  • Laura Mauri,
  • Franco Mazzini,
  • Clarissa Mazzotta,
  • Rosa Maria Mele,
  • Stefano Meneghetti,
  • Annalisa Micheli,
  • Francesca Miciotto,
  • Massimo Milani,
  • Stella Vittoria Milone,
  • Antonella Minutoli,
  • Donatella Moggia,
  • Maria Chiara Molinari,
  • Annalisa Monolo,
  • Enrico Montagnani,
  • Angela Maria Monteleone,
  • Silvia Moretti,
  • Giulia Maria Morresi,
  • Angela Mortillaro,
  • Annunziata Muggeri,
  • Pierangela Mussinu,
  • Carmen Muzzolini,
  • Anna Naccari,
  • Sara Nappini,
  • Immacolata Naso,
  • Novella Natale,
  • Marina Navarra,
  • Laura Nicoletti,
  • Flavia Nicoloso,
  • Erica Nistri,
  • Monika Nitsch,
  • Cristina Novarini,
  • Laura Maria Olimpi,
  • Riccardo Ongaro,
  • Maria Maddalena Palma,
  • Miriam Pambianchi,
  • Angela Panariello,
  • Vittorio Pandolfini,
  • Stefano Pantano,
  • Michael Panzenberger,
  • Antonella Parlati,
  • Enza Daniela Parrinello,
  • Angela Pasinato,
  • Andrea Passarella,
  • Davide Pata,
  • Viviana Dora Patianna,
  • Pasquale Pazzola,
  • Chiara Maria Pedrazzi,
  • Monica Perin,
  • Vanessa Perone,
  • Cristina Perrera,
  • Danilo Perri,
  • Alberina Perrone,
  • Sabrina Persia,
  • Carla Alejandra Peruzzetto,
  • Silvana Rosa Pescosolido,
  • Giovanni Petrazzuoli,
  • Giuseppe Petrotto,
  • Vanna Piazza,
  • Patrizia Picco,
  • Elvira Pinelli,
  • Ambrogina Pirola,
  • Lorena Pisanello,
  • Daniele Pittarello,
  • Eleonora Polidoro,
  • Roberto Ponti,
  • Elena Porro,
  • Adolfo Francesco Porto,
  • Alfonsina Postiglione,
  • Alfiero Prandoni,
  • Elisabetta Profumo,
  • Chiara Protano,
  • Antonino Puma,
  • Maria Paola Puocci,
  • Anna Lucia Quitadamo,
  • Ruth Raffeiner,
  • Ferdinando Ragazzon,
  • Giulia Reghelin,
  • Paolo Regini,
  • Andrea Righetti,
  • Riccardo Righini,
  • Rosaria Rizzari,
  • Maria Oliva Rizzi,
  • Enrica Romano,
  • Cristiano Rosafio,
  • Paolo Rosas,
  • Rino Rosignoli,
  • Matilde Rossi,
  • Mariella Rossitto,
  • Bruno Ruffato,
  • Lucia Ruggieri,
  • Francesca Rusalen,
  • Annamaria Ruscitti,
  • Annarita Russo,
  • Pietro Salamone,
  • Cristina Salvatori,
  • Daniela Sambugaro,
  • Francesco Emilio Sanfilippo,
  • Luigi Saretta,
  • Vittoria Sarno,
  • Marcella Sasso,
  • Renato Savastano,
  • Valentina Savio,
  • Antonio Scarcella,
  • Ghislaine Sciarone,
  • Nico Maria Sciolla,
  • Antonio Scorrano,
  • Maria Sellitto,
  • Flavio Semenzato,
  • Rossella Semenzato,
  • Paolo Senesi,
  • Martina Serafini,
  • Daniela Maria Sgroi,
  • Romina Silenzi,
  • Carla Silvan,
  • Giorgia Soldà,
  • Martina Soliani,
  • Cristina Spagnoli,
  • Valter Spanevello,
  • Sergio Maria Speciale,
  • Sabrina Spedale,
  • Francesco Speranza,
  • Sara Stefani,
  • Francesco Storelli,
  • Gianni Tamassia,
  • Paolo Tambaro,
  • Anna Taveggia,
  • Albino Terenghi,
  • Luisa Toderini,
  • Marco Todeschini Premuda,
  • Giacomo Toffol,
  • Gabriele Tonelli,
  • Ilaria Tosetto,
  • Miro Trebbi,
  • Silvia Tulone,
  • Angelo Giuseppe Tummarello,
  • Antonella Ulliana,
  • Cristina Vallongo,
  • Sergio Venditti,
  • Claudia Ventrici,
  • Leonello Venturelli,
  • Giulia Vigo,
  • Maria Grazia Vitale,
  • Sergio Vivarelli,
  • Francescopaolo Volpe,
  • Concetta Volpe,
  • Barbara Vonella,
  • Aldo Vozzi,
  • Paola Wagner,
  • Giulia Zanon,
  • Chiara Zarbo ,
  • Maria Luisa Zuccolo

摘要

Pharyngitis is a major contributor to antibiotic overuse in paediatric primary care, thereby driving antimicrobial resistance. Distinguishing group A β-hemolytic streptococcus (GABHS) from non-specific pharyngitis is crucial, as it directly influences treatment decisions. Post-COVID-19 changes in infection patterns and prescribing baehaviours have been observed. This study investigates the epidemiology, management, and outcomes of paediatric pharyngitis using data from the Pedianet network. Episodes of pharyngitis occurring between January 2010 and September 2024 among children aged 0–14 years were included and classified as GABHS, and in a heterogeneour category named non-specific pharyngitis. Antibiotic prescriptions within 14 days after the diagnosis were considered. Descriptive statistics, incidence rates, prescription rates, and logistic models were used to describe these patterns and evaluate the association between antibiotic use and access to Emergency Room (ER) or hospitalization for any cause within 15 days after the diagnosis. Results from logistic regression analyses were reported as odds ratios (ORs) and 95% confidence intervals (95%CIs). A total of 567,705 episodes of pharyngitis were included (18.8% GABHS and 81.2% non-specific pharyngitis). Pharyngitis mainly affected preschool and school-age children (43.5% and 25.9% in those aged 2–<6 and 6–<11 years, respectively), whereas non-specific pharyngitis also involved children younger than two years (27.5%). Overall incidence rates declined over time, except for GABHS pharyngitis in the post-COVID-19 period (7.22 events per 100 person-years). Almost all GABHS pharyngitis cases were treated, while a portion of non-specific pharyngitis cases remained untreated. Amoxicillin was the most prescribed antibiotic, but during and post-COVID-19 pandemic, broader-spectrum antibiotics were used more frequently than in the pre-pandemic period. Treatment in children diagnosed with non-specific pharyngitis was associated with a 49% (OR=1.49, 95%CI:1.33–1.66) significantly higher risk of access to ER or hospitalization for all cause, while no association was found in GABHS pharyngitis (OR=0.91, 95%CI:0.69–1.21). The post-COVID-19 incidence peak of pharyngitis may reflect an immunity gap among children. Guideline-based antibiotic use remains essential to prevent complications and antimicrobial resistance,therby optimizing the management of pharyngitis.