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

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.