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Evidence-Based Complementary and Alternative Medicine
Volume 2014 (2014), Article ID 243801, 17 pages
http://dx.doi.org/10.1155/2014/243801
Research Article

Antibiotic Use in Children with Acute Respiratory or Ear Infections: Prospective Observational Comparison of Anthroposophic and Conventional Treatment under Routine Primary Care Conditions

1Institute for Applied Epistemology and Medical Methodology, University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg, Germany
2Paediatric Practice, Quellengasse 42, 8010 Graz, Austria
3Integrative Medicine Institute, Overton Street, Portland, OR 97210, USA
4University of Applied Sciences Leiden, Zernikedreef 11, 2333 CK Leiden, The Netherlands
5Louis Bolk Instituut, Hoofdstraat 24, 3972 LA Driebergen-Rijsenburg, The Netherlands

Received 7 July 2014; Revised 21 October 2014; Accepted 21 October 2014; Published 18 November 2014

Academic Editor: Jairo K. Bastos

Copyright © 2014 Harald J. Hamre et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. D. K. Cherry, C. W. Burt, and D. A. Woodwell, “National Ambulatory Medical Care Survey: 2001 summary,” Advance Data, no. 337, pp. 1–44, 2003. View at Google Scholar · View at Scopus
  2. A. I. O. Plasschaert, M. M. Rovers, A. G. M. Schilder, T. J. M. Verheij, and E. Hak, “Trends in doctor consultations, antibiotic prescription, and specialist referrals for otitis media in children: 1995–2003,” Pediatrics, vol. 117, no. 6, pp. 1879–1886, 2006. View at Publisher · View at Google Scholar · View at Scopus
  3. M. Andre, Å. Vernby, I. Odenholt et al., “Diagnosis-prescribing surveys in 2000, 2002 and 2005 in Swedish general practice: consultations, diagnosis, diagnostics and treatment choices,” Scandinavian Journal of Infectious Diseases, vol. 40, no. 8, pp. 648–654, 2008. View at Publisher · View at Google Scholar · View at Scopus
  4. J. de Jong, P. B. van den Berg, T. W. de Vries, and L. T. W. de Jong-van den Berg, “Antibiotic drug use of children in the Netherlands from 1999 till 2005,” European Journal of Clinical Pharmacology, vol. 64, no. 9, pp. 913–919, 2008. View at Publisher · View at Google Scholar · View at Scopus
  5. P. L. Thompson, R. E. Gilbert, P. F. Long, S. Saxena, M. Sharland, and I. C. K. Wong, “Has UK guidance affected general practitioner antibiotic prescribing for otitis media in children?” Journal of Public Health, vol. 30, no. 4, pp. 479–486, 2008. View at Publisher · View at Google Scholar · View at Scopus
  6. P. L. Thompson, N. Spyridis, M. Sharland et al., “Changes in clinical indications for community antibiotic prescribing for children in the UK from 1996 to 2006: will the new NICE prescribing guidance on upper respiratory tract infections just be ignored?” Archives of Disease in Childhood, vol. 94, no. 5, pp. 337–340, 2009. View at Publisher · View at Google Scholar · View at Scopus
  7. S. B. Meropol, Z. Chen, and J. P. Metlay, “Reduced antibiotic prescribing for acute respiratory infections in adults and children,” The British Journal of General Practice, vol. 59, no. 567, pp. e321–e328, 2009. View at Publisher · View at Google Scholar · View at Scopus
  8. A. M. M. van Deursen, T. J. M. Verheij, M. M. Rovers et al., “Trends in primary-care consultations, comorbidities, and antibiotic prescriptions for respiratory infections in the Netherlands before implementation of pneumococcal vaccines for infants,” Epidemiology & Infection, vol. 140, no. 5, pp. 823–834, 2012. View at Publisher · View at Google Scholar · View at Scopus
  9. A. Spinks, P. P. Glasziou, and C. B. del Mar, “Antibiotics for sore throat,” The Cochrane Database of Systematic Reviews, vol. 11, Article ID CD000023, 2013. View at Google Scholar · View at Scopus
  10. S. M. Smith, T. Fahey, J. Smucny, and L. A. Becker, “Antibiotics for acute bronchitis,” Cochrane Database of Systematic Reviews, vol. 4, Article ID CD000245, 2014. View at Publisher · View at Google Scholar
  11. T. Kenealy and B. Arroll, “Antibiotics for the common cold and acute purulent rhinitis,” The Cochrane Database of Systematic Reviews, vol. 6, Article ID CD000247, 2013. View at Publisher · View at Google Scholar · View at Scopus
  12. R. P. Venekamp, S. Sanders, P. P. Glasziou, C. B. Del Mar, and M. M. Rovers, “Antibiotics for acute otitis media in children,” Cochrane Database of Systematic Reviews, vol. 1, Article ID CD000219, 2013. View at Google Scholar · View at Scopus
  13. R. M. Rosenfeld and D. Kay, “Natural history of untreated otitis media,” Laryngoscope, vol. 113, no. 10, pp. 1645–1657, 2003. View at Publisher · View at Google Scholar · View at Scopus
  14. I. Petersen, A. M. Johnson, A. Islam, G. Duckworth, D. M. Livermore, and A. C. Hayward, “Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database,” The British Medical Journal, vol. 335, no. 7627, pp. 982–984, 2007. View at Publisher · View at Google Scholar · View at Scopus
  15. R. Wise, T. Hart, O. Cars et al., “Antimicrobial resistance,” The British Medical Journal, vol. 317, no. 7159, pp. 609–610, 1998. View at Publisher · View at Google Scholar · View at Scopus
  16. N. Bezáková, R. A. M. J. Damoiseaux, A. W. Hoes, A. G. M. Schilder, and M. M. Rovers, “Recurrence up to 3.5 years after antibiotic treatment of acute otitis media in very young Dutch children: survey of trial participants,” The British Medical Journal, vol. 339, Article ID b2525, 2009. View at Publisher · View at Google Scholar · View at Scopus
  17. F. Marra, C. A. Marra, K. Richardson et al., “Antibiotic use in children is associated with increased risk of asthma,” Pediatrics, vol. 123, no. 3, pp. 1003–1010, 2009. View at Publisher · View at Google Scholar · View at Scopus
  18. H. Farquhar, A. Stewart, E. Mitchell et al., “The role of paracetamol in the pathogenesis of asthma,” Clinical and Experimental Allergy, vol. 40, no. 1, pp. 32–41, 2010. View at Publisher · View at Google Scholar · View at Scopus
  19. K. R. Risnes, K. Belanger, W. Murk, and M. B. Bracken, “Antibiotic exposure by 6 months and asthma and allergy at 6 years: findings in a cohort of 1,401 US children,” The American Journal of Epidemiology, vol. 173, no. 3, pp. 310–318, 2011. View at Publisher · View at Google Scholar · View at Scopus
  20. J. Penders, I. Kummeling, and C. Thijs, “Infant antibiotic use and wheeze and asthma risk: a systematic review and meta-analysis,” European Respiratory Journal, vol. 38, no. 2, pp. 295–302, 2011. View at Publisher · View at Google Scholar · View at Scopus
  21. J. Schmitt, N. M. Schmitt, W. Kirch, and M. Meurer, “Early exposure to antibiotics and infections and the incidence of atopic eczema: a population-based cohort study,” Pediatric Allergy and Immunology, vol. 21, no. 2, part 1, pp. 292–300, 2010. View at Publisher · View at Google Scholar · View at Scopus
  22. S. Y. Shaw, J. F. Blanchard, and C. N. Bernstein, “Association between the use of antibiotics in the first year of life and pediatric inflammatory bowel disease,” The American Journal of Gastroenterology, vol. 105, no. 12, pp. 2687–2692, 2010. View at Publisher · View at Google Scholar · View at Scopus
  23. S. Y. Shaw, J. F. Blanchard, and C. N. Bernstein, “Association between the use of antibiotics and new diagnoses of Crohn's disease and ulcerative colitis,” American Journal of Gastroenterology, vol. 106, no. 12, pp. 2133–2142, 2011. View at Publisher · View at Google Scholar · View at Scopus
  24. A. Hviid, H. Svanström, and M. Frisch, “Antibiotic use and inflammatory bowel diseases in childhood,” Gut, vol. 60, no. 1, pp. 49–54, 2011. View at Publisher · View at Google Scholar · View at Scopus
  25. Communication from The Commission to the European Parliament and the Council, Action Plan against the Rising Threats from Antimicrobial Resistance, European Commission, Brussels, Belgium, 2011.
  26. A. Majeed and T. Harris, “Acute otitis media in children,” The British Medical Journal, vol. 315, no. 7104, pp. 321–322, 1997. View at Publisher · View at Google Scholar · View at Scopus
  27. S. F. Dowell, S. M. Marcy, W. R. Phillips, M. A. Gerber, and B. Schwartz, “Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections,” Pediatrics, vol. 101, no. 1, pp. 163–165, 1998. View at Google Scholar · View at Scopus
  28. R. Gonzales, J. G. Bartlett, R. E. Besser et al., “Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods,” Annals of Internal Medicine, vol. 134, no. 6, pp. 479–486, 2001. View at Publisher · View at Google Scholar · View at Scopus
  29. J. V. Hirschmann, “Antibiotics for common respiratory tract infections in adults,” Archives of Internal Medicine, vol. 162, no. 3, pp. 256–264, 2002. View at Publisher · View at Google Scholar · View at Scopus
  30. S. Mölstad, “Reduction in antibiotic prescribing for respiratory tract infections is needed!,” Scandinavian Journal of Primary Health Care, vol. 21, no. 4, pp. 196–198, 2003. View at Publisher · View at Google Scholar · View at Scopus
  31. T. Andrews, M. Thompson, D. I. Buckley et al., “Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: a systematic review and Meta-Analysis,” PLoS ONE, vol. 7, no. 1, Article ID e30334, 2012. View at Publisher · View at Google Scholar · View at Scopus
  32. R. Thibeault, R. Gilca, S. Côté, G. de Serres, G. Boivin, and E. P. Déry, “Antibiotic use in children is not influenced by the result of rapid antigen detection test for the respiratory syncytial virus,” Journal of Clinical Virology, vol. 39, no. 3, pp. 169–174, 2007. View at Publisher · View at Google Scholar · View at Scopus
  33. D. M. Spiro, K.-Y. Tay, D. H. Arnold, J. D. Dziura, M. D. Baker, and E. D. Shapiro, “Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial,” The Journal of the American Medical Association, vol. 296, no. 10, pp. 1235–1241, 2006. View at Publisher · View at Google Scholar · View at Scopus
  34. G. K. Spurling, C. B. Del Mar, L. Dooley, and R. Foxlee, “Delayed antibiotics for respiratory infections,” Cochrane Database of Systematic Reviews, no. 3, Article ID CD004417, 2007. View at Google Scholar · View at Scopus
  35. R. M. Siegel, “Acute otitis media guidelines, antibiotic use, and shared medical decision-making,” Pediatrics, vol. 125, no. 2, pp. 384–386, 2010. View at Publisher · View at Google Scholar · View at Scopus
  36. C. I. Schulman, N. Namias, J. Doherty et al., “The effect of antipyretic therapy upon outcomes in critically ill patients: a randomized, prospective study,” Surgical Infections, vol. 6, no. 4, pp. 369–375, 2005. View at Publisher · View at Google Scholar · View at Scopus
  37. P. Nourjah, S. R. Ahmad, C. Karwoski, and M. Willy, “Estimates of acetaminophen (paracetamol)-associated overdoses in the United States,” Pharmacoepidemiology and Drug Safety, vol. 15, no. 6, pp. 398–405, 2006. View at Publisher · View at Google Scholar · View at Scopus
  38. R. Beasley, T. Clayton, J. Crane et al., “Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6-7 years: analysis from phase three of the ISAAC programme,” The Lancet, vol. 372, no. 9643, pp. 1039–1048, 2008. View at Publisher · View at Google Scholar · View at Scopus
  39. E. Bakkeheim, P. Mowinckel, K. H. Carlsen, G. Håland, and K. C. L. Carlsen, “Paracetamol in early infancy: the risk of childhood allergy and asthma,” Acta Paediatrica, vol. 100, no. 1, pp. 90–96, 2011. View at Publisher · View at Google Scholar · View at Scopus
  40. G. Wennergren, “Paracetamol—accumulating reports of an association with allergy and asthma,” Acta Paediatrica, vol. 100, no. 1, pp. 12–13, 2011. View at Publisher · View at Google Scholar · View at Scopus
  41. A. Amberbir, G. Medhin, A. Alem, J. Britton, G. Davey, and A. Venn, “The role of acetaminophen and geohelminth infection on the incidence of wheeze and eczema: a longitudinal birth-cohort study,” American Journal of Respiratory and Critical Care Medicine, vol. 183, no. 2, pp. 165–170, 2011. View at Publisher · View at Google Scholar · View at Scopus
  42. E. M. Sarrell, A. Mandelberg, and H. A. Cohen, “Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media,” Archives of Pediatrics and Adolescent Medicine, vol. 155, no. 7, pp. 796–799, 2001. View at Publisher · View at Google Scholar · View at Scopus
  43. E. M. Sarrell, H. A. Cohen, and E. Kahan, “Naturopathic treatment for ear pain in children,” Pediatrics, vol. 111, no. 5, pp. e574–e579, 2003. View at Publisher · View at Google Scholar · View at Scopus
  44. T. P. U. Wustrow, “Naturheilkundliche Therapie der akuten Otitis media. Eine Alternative zum primären Antibiotikaeinsatz. Naturopathic therapy for acute otitis media. An alternative to the primary use of antibiotics,” HNO, vol. 53, no. 8, pp. 728–734, 2005. View at Publisher · View at Google Scholar · View at Scopus
  45. K.-H. Friese, S. Kruse, R. Lüdtke, and H. Moeller, “The homoeopathic treatment of otitis media in children—comparisons with conventional therapy,” International Journal of Clinical Pharmacology and Therapeutics, vol. 35, no. 7, pp. 296–301, 1997. View at Google Scholar · View at Scopus
  46. J. Jacobs, D. A. Springer, and D. Crothers, “Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial,” Pediatric Infectious Disease Journal, vol. 20, no. 2, pp. 177–183, 2001. View at Publisher · View at Google Scholar · View at Scopus
  47. M. Haidvogl, D. S. Riley, M. Heger et al., “Homeopathic and conventional treatment for acute respiratory and ear complaints: a comparative study on outcome in the primary care setting,” BMC Complementary and Alternative Medicine, vol. 7, article 7, 2007. View at Publisher · View at Google Scholar · View at Scopus
  48. G. Büttner, “Die Behandlung der akuten Otitis media ohne Sulfonamide und Antibiotika in einer Allgemeinpraxis [Treatment of acute otitis media without sulphonamides and antibiotics in general practice],” Beiträge zu einer Erweiterung der Heilkunst, vol. 26, pp. 125–129, 1973. View at Google Scholar
  49. R. Fried, “My experiences with acute and chronic middle ear inflammations in children,” Journal of Anthroposophical Medicine, vol. 7, no. 1, pp. 48–51, 1990. View at Google Scholar
  50. F. Husemann, “Scharlach und eitrige Angina in zehn Jahren Praxis [Scarlet fever and suppurative tonsillitis-a ten-year practice study],” Der Merkurstab, vol. 51, no. 1, pp. 16–24, 1998. View at Google Scholar
  51. E. Jeschke, C. Lüke, T. Ostermann, M. Tabali, J. Hübner, and H. Matthes, “Prescribing practices in the treatment of upper respiratory tract infections in anthroposophic medicine,” Forschende Komplementarmedizin, vol. 14, no. 4, pp. 207–215, 2007. View at Publisher · View at Google Scholar · View at Scopus
  52. J. L. Cosby, N. Francis, and C. C. Butler, “The role of evidence in the decline of antibiotic use for common respiratory infections in primary care,” Lancet Infectious Diseases, vol. 7, no. 11, pp. 749–756, 2007. View at Publisher · View at Google Scholar · View at Scopus
  53. H. J. Hamre, M. Fischer, M. Heger et al., “Anthroposophic vs. conventional therapy of acute respiratory and ear infections: a prospective outcomes study,” Wiener Klinische Wochenschrift, vol. 117, no. 7-8, pp. 256–268, 2005. View at Publisher · View at Google Scholar · View at Scopus
  54. T. Lasky, “Estimates of pediatric medication use in the United States: current abilities and limitations,” Clinical Therapeutics, vol. 31, no. 2, pp. 436–445, 2009. View at Publisher · View at Google Scholar · View at Scopus
  55. Z. Grossman, S. del Torso, A. Hadjipanayis, D. van Esso, A. Drabik, and M. Sharland, “Antibiotic prescribing for upper respiratory infections: European primary paediatricians' knowledge, attitudes and practice,” Acta Paediatrica, vol. 101, no. 9, pp. 935–940, 2012. View at Publisher · View at Google Scholar · View at Scopus
  56. M. P. Joseph, P. J. Craig, and D. P. Caldwell, “Clinical trials in children,” British Journal of Clinical Pharmacology, 2013. View at Publisher · View at Google Scholar
  57. A. L. Kozyrskyj, A. G. Carrie, G. B. Mazowita, L. M. Lix, T. P. Klassen, and B. J. Law, “Decrease in antibiotic use among children in the 1990s: not all antibiotics, not all children,” Canadian Medical Association Journal, vol. 171, no. 2, pp. 133–138, 2004. View at Publisher · View at Google Scholar · View at Scopus
  58. R. Steiner and I. Wegman, Extending Practical Medicine: Fundamental Principles Based on the Science of the Spirit, First Published 1925, Rudolf Steiner Press, Bristol, UK, 2000.
  59. G. S. Kienle, H. U. Albonico, E. Baars, H. J. Hamre, P. Zimmermann, and H. Kiene, “Anthroposophic medicine: an integrative medical system originating in europe,” Global Advances in Health and Medicine, vol. 2, no. 6, pp. 20–31, 2013. View at Google Scholar
  60. F. Husemann and O. Wolff, The Anthroposophical Approach to Medicine, vol. 2, Rudolf Steiner Press, London, UK, 1987.
  61. M. Evans and I. Rodger, Anthroposophical Medicine: Healing for Body, Soul and Spirit, Thorsons, London, UK, 1992.
  62. J. Ritchie, J. Wilkinson, M. Gantley, G. Feder, Y. Carter, and J. Formby, A Model of Integrated Primary Care: Anthroposophic Medicine, Department of General Practice and Primary Care, St Bartholomew's and the Royal London School of Medicine, Queen Mary, University of London, London, UK, 2001.
  63. R. Lang-Roth, E. Rietschel, S. van Koningsbruggen, and R. Schwarz, “Erkrankungen des Hals-Nasen-Ohren-Bereiches [Ear-nose-throat diseases],” in Pädiatrie Integrativ. Konventionelle und Komplementäre Therapie [Integrative Pediatrics. Conventional and Complementary Treatment], E. Schönau, E. G. Naumann, A. Längler, and J. Beuth, Eds., pp. 392–427, Elsevier, München, Germany, 2005. View at Google Scholar
  64. G. Soldner and H. M. Stellmann, Individual Paediatrics: Physical, Emotional and Spiritual Aspects of Diagnosis and Counseling. Anthroposophic-Homeopathic Therapy, Wissenschaftliche Verlagsgesellschaft, Stuttgart, Germany, 2014.
  65. Anthroposophic Pharmaceutical Codex APC, International Association of Anthroposophic Pharmacists, Dornach, Switzerland, 3rd edition, 2013.
  66. M.-L. Buchholzer, C. Werner, and W. Knoess, “Current concepts on integrative safety assessment of active substances of botanical, mineral or chemical origin in homeopathic medicinal products within the European regulatory framework,” Regulatory Toxicology and Pharmacology, vol. 68, no. 2, pp. 193–200, 2014. View at Publisher · View at Google Scholar · View at Scopus
  67. G. S. Kienle, H. Kiene, and H. U. Albonico, Anthroposophic Medicine: Effectiveness, Utility, Costs, Safety, Schattauer, Stuttgart, Germany, 2006.
  68. H. J. Hamre, H. Kiene, and G. S. Kienle, “Clinical research in anthroposophic medicine,” Alternative Therapies in Health and Medicine, vol. 15, no. 6, pp. 52–55, 2009. View at Google Scholar · View at Scopus
  69. V. Fønnebø, S. Grimsgaard, H. Walach et al., “Researching complementary and alternative treatments—the gatekeepers are not at home,” BMC Medical Research Methodology, vol. 7, article 7, 2007. View at Publisher · View at Google Scholar · View at Scopus
  70. P. E. Shrout and J. L. Fleiss, “Intraclass correlations: uses in assessing rater reliability,” Psychological Bulletin, vol. 86, no. 2, pp. 420–428, 1979. View at Publisher · View at Google Scholar · View at Scopus
  71. D. W. Hosmer and S. Lemeshow, Applied Logistic Refression, John Wiley & Sons, New York, NY, USA, 2nd edition, 2000.
  72. S. Menard, Applied Logistic Regression Analysis, Sage Publications, Thousand Oaks, Calif, USA, 2nd edition, 2002.
  73. H. J. Hamre, A. Glockmann, W. Tröger, G. S. Kienle, and H. Kiene, “Assessing the order of magnitude of outcomes in single-arm cohorts through systematic comparison with corresponding cohorts: an example from the AMOS study,” BMC Medical Research Methodology, vol. 8, article 11, 2008. View at Publisher · View at Google Scholar · View at Scopus
  74. E. von Elm, M. Egger, D. G. Altman, S. J. Pocock, P. C. Gøtzsche, and J. P. Vandenbroucke, “Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies,” British Medical Journal, vol. 335, no. 7624, pp. 806–808, 2007. View at Publisher · View at Google Scholar · View at Scopus
  75. S. Abbas, P. Ihle, L. Heymans, J. Küpper-Nybelen, and I. Schubert, “Differences in antibiotic prescribing between general practitioners and pediatricians in Hesse, Germany,” Deutsche Medizinische Wochenschrift, vol. 135, no. 37, pp. 1792–1797, 2010. View at Publisher · View at Google Scholar · View at Scopus
  76. D. Ashe, P. A. Patrick, M. M. Stempel, Q. Shi, and D. A. Brand, “Educational posters to reduce antibiotic use,” Journal of Pediatric Health Care, vol. 20, no. 3, pp. 192–197, 2006. View at Publisher · View at Google Scholar · View at Scopus
  77. M. Ashworth, J. Charlton, R. Latinovic, and M. Gulliford, “Age-related changes in consultations and antibiotic prescribing for acute respiratory infections, 1995–2000. Data from the UK General Practice Research Database,” Journal of Clinical Pharmacy and Therapeutics, vol. 31, no. 5, pp. 461–467, 2006. View at Publisher · View at Google Scholar · View at Scopus
  78. A. Chung, R. Perera, A. B. Brueggemann et al., “Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study,” British Medical Journal, vol. 335, no. 7617, pp. 429–431, 2007. View at Publisher · View at Google Scholar · View at Scopus
  79. A. Coco, L. Vernacchio, M. Horst, and A. Anderson, “Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline,” Pediatrics, vol. 125, no. 2, pp. 214–220, 2010. View at Publisher · View at Google Scholar · View at Scopus
  80. A. Harnden, R. Perera, A. B. Brueggemann et al., “Respiratory infections for which general practitioners consider prescribing an antibiotic: a prospective study,” Archives of Disease in Childhood, vol. 92, no. 7, pp. 594–597, 2007. View at Publisher · View at Google Scholar · View at Scopus
  81. J. H. Uijen, P. J. Bindels, F. G. Schellevis, and J. C. van der Wouden, “ENT problems in Dutch children: trends in incidence rates, antibiotic prescribing and referrals 2002–2008,” Scandinavian Journal of Primary Health Care, vol. 29, no. 2, pp. 75–79, 2011. View at Publisher · View at Google Scholar · View at Scopus
  82. I. H. Zuckerman, E. N. Perencevich, and A. D. Harris, “Concurrent acute illness and comorbid conditions poorly predict antibiotic use in upper respiratory tract infections: a cross-sectional analysis,” BMC Infectious Diseases, vol. 7, article 47, 2007. View at Publisher · View at Google Scholar · View at Scopus
  83. H. J. Hamre, A. Glockmann, M. Fischer, D. S. Riley, E. Baars, and H. Kiene, “Use and safety of anthroposophic medications for acute respiratory and ear infections: a prospective cohort study,” Drug Target Insights, vol. 2, pp. 209–219, 2007. View at Google Scholar
  84. A. E. Akkerman, M. M. Kuyvenhoven, J. C. van der Wouden, and T. J. M. Verheij, “Prescribing antibiotics for respiratory tract infections by GPs: management and prescriber characteristics,” British Journal of General Practice, vol. 55, no. 511, pp. 114–118, 2005. View at Google Scholar · View at Scopus
  85. J. Salomon, A. Sommet, C. Bernède, C. Tonéatti, C. Carbon, and D. Guillemot, “Antibiotics for nasopharyngitis are associated with a lower risk of office-based physician visit for acute otitis media within 14 days for 3- to 6-year-old children,” Journal of Evaluation in Clinical Practice, vol. 14, no. 4, pp. 595–599, 2008. View at Publisher · View at Google Scholar · View at Scopus
  86. G. Elshout, Y. Van Ierland, A. M. Bohnen et al., “Alarm signs and antibiotic prescription in febrile children in primary care: an observational cohort study,” British Journal of General Practice, vol. 63, no. 612, pp. e437–e444, 2013. View at Publisher · View at Google Scholar · View at Scopus
  87. P. Little, B. Stuart, F. D. R. Hobbs et al., “Antibiotic prescription strategies for acute sore throat: a prospective observational cohort study,” The Lancet Infectious Diseases, vol. 14, no. 3, pp. 213–219, 2014. View at Publisher · View at Google Scholar · View at Scopus
  88. G. Soldner and H. M. Stellmann, Individuelle Pädiatrie: Leibliche, seelische und geistige Aspekte in Diagnostik und Beratung, Anthroposophisch-homöopathische Therapie, Wissenschaftliche Verlagsgesellschaft, Stuttgart, Germany, 4th edition, 2011.
  89. E. Schönau, E. G. Naumann, A. Längler, and J. Beuth, Pädiatrie Integrativ. Konventionelle und Komplementäre Therapie [Integrative Pediatrics. Conventional and Complementary Treatment], Elsevier, München, Germany, 2005.
  90. J. Vagedes and G. Soldner, Das Kinder-Gesundheitsbuch: Kinderkrankheiten ganzheitlich vorbeugen und heilen, Gräfe und Unzer, Munich, Germany, 2008.
  91. H. M. Stellmann and G. Soldner, Kinderkrankheiten Natürlich Behandeln [Natural Treatment of Childhood Diseases], Gräfe und Unzer, München, Germany, 2014.
  92. J. K. Lindsey, Applying Generalized Linear Models, Springer, New York, NY, USA, 1997.
  93. G. S. Kienle, H.-U. Albonico, L. Fischer et al., “Complementary therapy systems and their integrative evaluation,” Explore: The Journal of Science and Healing, vol. 7, no. 3, pp. 175–187, 2011. View at Publisher · View at Google Scholar · View at Scopus
  94. J. S. Alm, J. Swartz, G. Lilja, A. Scheynius, and G. Pershagen, “Atopy in children of families with an anthroposophic lifestyle,” The Lancet, vol. 353, no. 9163, pp. 1485–1488, 1999. View at Publisher · View at Google Scholar · View at Scopus
  95. H. Flöistrup, J. Swartz, A. Bergström et al., “Allergic disease and sensitization in Steiner school children,” Journal of Allergy and Clinical Immunology, vol. 117, no. 1, pp. 59–66, 2006. View at Publisher · View at Google Scholar · View at Scopus
  96. J. S. Alm, J. Swartz, B. Björkstén et al., “An anthroposophic lifestyle and intestinal microflora in infancy,” Pediatric Allergy and Immunology, vol. 13, no. 6, pp. 402–411, 2002. View at Publisher · View at Google Scholar · View at Scopus
  97. R. Ziegler, “Mistletoe preparation iscador: are there methodological concerns with respect to controlled clinical trials?” Evidence-Based Complementary and Alternative Medicine, vol. 6, no. 1, pp. 19–30, 2009. View at Publisher · View at Google Scholar · View at Scopus
  98. U. Meyer, “Anwendungsbeobachtung WALA Plantago-Bronchialbalsam [Observational study of WALA Plantago Bronchial Balm],” Der Merkurstab, vol. 56, no. 4, pp. 208–209, 2003. View at Google Scholar
  99. C. Rother and P. Steigerwald, “Effectiveness and safety of the anthroposophic medicinal product Ferrum phosphoricum comp. for prodromal and manifest influenza,” Der Merkurstab, vol. 60, no. 5, pp. 464–470, 2007. View at Google Scholar
  100. G. S. Kienle, H. Kiene, and H. U. Albonico, Ulbricht 1991 [Pseudorandomised Comparative Study on the Influence of Body-Temperature Enemas on Fever]. Anthroposophic Medicine: Effectiveness, Utility, Costs, Safety, Schattauer, Stuttgart, Germany, 2006.