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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The current issue of <span class="elsevierStyleSmallCaps">Anales de Pediatr&#237;a</span> features an article that analyses the association between high frequency of health care use and the rate of antibiotic prescription&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> It is a high-quality population-based study conducted from the network of paediatricians involved in research of the Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a de Atenci&#243;n Primaria &#40;Spanish Association of Primary Care Paediatrics&#41;&#44; known as PAP&#46;en&#46;RED &#40;<a id="intr0010" class="elsevierStyleInterRef" href="http://www.aepap.org/grupos/papenred">http&#58;&#47;&#47;www&#46;aepap&#46;org&#47;grupos&#47;papenred</a>&#41;&#44; and promoted by its Research Group&#46; Based on data from 2&#44;726 patients&#44; the study found that the rate of antibiotic prescription was significantly higher in high-frequency users compared to infrequent users in every paediatric age group&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">While the accessibility to paediatric care is one of the greatest strengths of our public health system&#44; it may also be one of its greatest weaknesses when it comes to the adequate use of resources and the rational use of antibiotics&#46; In the context of febrile disease&#44; more than a few paediatric patients make repeated visits to health facilities &#40;in both the public and the private systems&#41; seeking care beyond the previously prescribed symptomatic treatment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In comparison with neighbouring countries in central and northern Europe&#44; antibiotic prescription in primary care &#40;PC&#41; paediatric services is noticeably higher in Spain&#44; at least in younger children&#46; A recent article on PC practices in 6 countries highlighted that antibiotic prescription in children aged less than 3 years in the Autonomous Community of Valencia was 3&#46;5 times greater compared to Norwegian children and 1&#46;5 times greater compared to German or North American children of the same age&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Furthermore&#44; 35&#37; of prescriptions were for amoxicillin combined with clavulanic acid&#44; compared to 25&#37; of prescriptions for amoxicillin&#44; which revealed inappropriate prescription practices&#46; Other articles published previously&#44; including the study by Malo et al&#46; in the entire paediatric population of Arag&#243;n &#40;year 2010&#59; 224&#44;780 documented episodes of acute respiratory tract infection&#41;&#44; have found that antibiotics are prescribed in up to 75&#37; of cases of acute pharyngitis &#40;theoretically&#44; only 30&#37; of these cases would be caused by streptococcus&#41;&#44; 72&#37; of cases of otitis&#44; 27&#37; of cases of bronchitis and 16&#37; of upper respiratory tract infections of undetermined aetiology&#46; Half the antibiotic prescriptions in this study were for amoxicillin&#44; and 25&#37; for amoxicillin-clavulanic acid&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> The study by Balaguer et al&#46; found improved rates of appropriate prescription&#58; 0&#46;45 prescriptions of penicillin&#47;amoxicillin per patient per year&#44; compared to 0&#46;19 prescriptions of penicillin combined with clavulanic acid&#46; In any case&#44; all the available data suggest that there is ample room for improvement in antibiotic prescription practices&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In addition to the excessive number of visits to health care facilities&#44; we need to ponder the presence of additional factors that contribute to this frequent and inappropriate use of antibiotics in Spain&#46; And this reflection&#44; based on data and rigorous analyses&#44; must result in the development of improvement measures&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We must remain aware that antimicrobial resistance is considered a threat of such magnitude that it was even addressed in the international G20 summit in Hamburg &#40;July 7&#8211;8&#44; 2017&#41;&#44; where participating nations agreed on the implementation of national action plans to achieve a global European health strategy based on the &#8220;one health&#8221; approach by the end of 2018&#46; Multidrug-resistant microorganisms are responsible for 700&#44;000 deaths a year worldwide&#44; and future projections&#44; should there be no intervention&#44; are not encouraging&#58; in 2050&#44; 10 million people could die due to antimicrobial resistance &#40;compare this with the current rate of 8&#46;2 million deaths&#47;year caused by cancer&#41;&#44; with the associated economic losses from now to that point estimated at 100 trillion dollars&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In Spain&#44; the Agencia Espa&#241;ola de Medicamentos y Productos Sanitarios &#40;Spanish Agency of Medicines and Medical Devices&#41; introduced the Plan Nacional frente a la Resistencia a los Antibi&#243;ticos &#40;National Plan against Antimicrobial Resistance &#91;PRAN&#93;&#44; <a id="intr0015" class="elsevierStyleInterRef" href="http://www.resistenciaantibioticos.es/es">http&#58;&#47;&#47;www&#46;resistenciaantibioticos&#46;es&#47;es</a>&#41; in 2014&#46; The plan involves the participation of a multidisciplinary group of human and veterinary health professionals &#40;including several paediatric scientific societies&#41; working on different strategic lines&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In addition to the obvious responsibility of the prescriber&#44; the specific document on the improvement goals that are a priority in primary care paediatrics developed within the PRAN &#40;<a id="intr0020" class="elsevierStyleInterRef" href="http://www.resistenciaantibioticos.es/es/system/files/content_images/objetivos_de_mejora_prioritarios_ap_pediatria.pdf">http&#58;&#47;&#47;www&#46;resistenciaantibioticos&#46;es&#47;es&#47;system&#47;files&#47;content&#95;images&#47;objetivos&#95;de&#95;mejora&#95;prioritarios&#95;ap&#95;pediatria&#46;pdf</a>&#41; points out factors at play in antibiotic use that go beyond its competences&#46; These include pharmacy dispensation without a prescription&#44; administration by families without medical guidance&#44; large caseloads that prevent adequate communication and health education&#44; lack of control of excessive health care use&#44; the low and random availability in PC clinics of rapid diagnostic tests&#44; lack of access to continuing education and the absence in the electronic health records system of integrated tools to aid clinical decision-making&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The document establishes clear objectives for prescribers&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">To reduce the overall frequency of prescription</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">To reduce prescription for non-bacterial illnesses</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">To improve the appropriateness of prescription in specific diseases</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">To achieve each objective&#44; the authors propose a series of measures&#44; some common to all three&#58; smaller caseloads &#40;to increase the time clinicians spend with each patient&#41;&#44; availability of rapid diagnostic tests in primary care clinics&#44; use of high-yield diagnostic tools &#40;pneumatic otoscopy and&#47;or tympanometry in cases of otitis&#41;&#44; availability of updated data on the specific prevalence of microbes and antimicrobial resistance at the local level&#44; development and integration of systems to guide decision-making in the electronic health records database&#44; and continuing education&#44; tied to productivity and professional development incentives&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Erroneous perceptions about the use and effectiveness of antibiotics still persist in Spain&#46; According to the 2016 Eurobarometer&#44; 48&#37; of the Spanish population believes that antibiotics kill viruses and 45&#37; believes they are effective against the common cold and the flu&#46; These widespread misconceptions probably put pressure on prescribers&#44; but reverting them involves health education&#44; which is the responsibility of health administrations through educational campaigns and also of clinicians through doctor&#47;patient communication &#40;in our case&#44; paediatrician&#47;family&#41; during medical visits&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">There are multiple clinical practice guidelines&#44; care protocols&#44; clinical pathways and consensus documents from scientific societies to guide appropriate antibiotic prescription&#46; We have available an electronic health records system that is generally effective and that could allow the integration of these recommendations or consensus guidelines in the health records&#44; in the form of diagnostic or treatment algorithms and of automated alerts in case of inappropriate prescription&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Lastly&#44; the specific goals dictated by the PRAN in relation to antibiotic prescription in the paediatric primary care setting are&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#46;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Reducing antibiotic prescription in nonbacterial illnesses &#40;colds&#44; laryngitis&#44; non-streptococcal pharyngitis&#44; bronchitis&#41;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Reducing to a minimum antimicrobial treatment of viral pharyngitis&#44; overall and particularly in children aged less than 3 years</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#46;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Reducing the use of macrolides and amoxicillin-clavulanic acid for treatment of tonsillitis</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4&#46;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Reducing the treatment of suspected urinary tract infections that have not been properly confirmed</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">5&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Reducing the use of antibiotics in cases of acute otitis media&#44; considering&#44; in most cases&#44; the approach of watchful waiting with analgesic and anti-inflammatory therapy and postponement of antibiotherapy based on patient progress and&#47;or re-evaluation</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">6&#46;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Avoiding antibiotherapy for treatment of bronchitis&#47;bronchiolitis in young children</p></li></ul></p><p id="par0110" class="elsevierStylePara elsevierViewall">Most of the prescriptions for antibiotherapy for children in Spain are made at the PC level&#44; so we must be aware than in prescribing antibiotics&#44; we may be contributing to the development of antimicrobial resistances or&#44; conversely&#44; that in not prescribing them we may be helping reduce the current rates of antimicrobial resistance&#46; There is much at stake&#46;</p></span>"
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Editorial
Antibiotics prescribing in paediatric primary care: A shared responsibility
Prescripción de antibióticos en pediatría de atención primaria: una responsabilidad compartida
César García Veraa,b,c,
Corresponding author
cgarciavera@gmail.com

Corresponding author.
, María Rosa Albañil Ballesterosb,c,d
a Centro de Salud José Ramón Muñoz Fernández, Servicio Aragonés de Salud, Zaragoza, Spain
b Grupo de Patología Infecciosa de la Asociación Española de Pediatría de Atención Primaria, Spain
c Asociación Española de Pediatría de Atención Primaria en el grupo de trabajo del Plan Nacional frente a la Resistencia a los Antibióticos (PRAN), Spain
d Centro de Salud Cuzco, Servicio Madrileño de Salud, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The current issue of <span class="elsevierStyleSmallCaps">Anales de Pediatr&#237;a</span> features an article that analyses the association between high frequency of health care use and the rate of antibiotic prescription&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> It is a high-quality population-based study conducted from the network of paediatricians involved in research of the Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a de Atenci&#243;n Primaria &#40;Spanish Association of Primary Care Paediatrics&#41;&#44; known as PAP&#46;en&#46;RED &#40;<a id="intr0010" class="elsevierStyleInterRef" href="http://www.aepap.org/grupos/papenred">http&#58;&#47;&#47;www&#46;aepap&#46;org&#47;grupos&#47;papenred</a>&#41;&#44; and promoted by its Research Group&#46; Based on data from 2&#44;726 patients&#44; the study found that the rate of antibiotic prescription was significantly higher in high-frequency users compared to infrequent users in every paediatric age group&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">While the accessibility to paediatric care is one of the greatest strengths of our public health system&#44; it may also be one of its greatest weaknesses when it comes to the adequate use of resources and the rational use of antibiotics&#46; In the context of febrile disease&#44; more than a few paediatric patients make repeated visits to health facilities &#40;in both the public and the private systems&#41; seeking care beyond the previously prescribed symptomatic treatment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In comparison with neighbouring countries in central and northern Europe&#44; antibiotic prescription in primary care &#40;PC&#41; paediatric services is noticeably higher in Spain&#44; at least in younger children&#46; A recent article on PC practices in 6 countries highlighted that antibiotic prescription in children aged less than 3 years in the Autonomous Community of Valencia was 3&#46;5 times greater compared to Norwegian children and 1&#46;5 times greater compared to German or North American children of the same age&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Furthermore&#44; 35&#37; of prescriptions were for amoxicillin combined with clavulanic acid&#44; compared to 25&#37; of prescriptions for amoxicillin&#44; which revealed inappropriate prescription practices&#46; Other articles published previously&#44; including the study by Malo et al&#46; in the entire paediatric population of Arag&#243;n &#40;year 2010&#59; 224&#44;780 documented episodes of acute respiratory tract infection&#41;&#44; have found that antibiotics are prescribed in up to 75&#37; of cases of acute pharyngitis &#40;theoretically&#44; only 30&#37; of these cases would be caused by streptococcus&#41;&#44; 72&#37; of cases of otitis&#44; 27&#37; of cases of bronchitis and 16&#37; of upper respiratory tract infections of undetermined aetiology&#46; Half the antibiotic prescriptions in this study were for amoxicillin&#44; and 25&#37; for amoxicillin-clavulanic acid&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> The study by Balaguer et al&#46; found improved rates of appropriate prescription&#58; 0&#46;45 prescriptions of penicillin&#47;amoxicillin per patient per year&#44; compared to 0&#46;19 prescriptions of penicillin combined with clavulanic acid&#46; In any case&#44; all the available data suggest that there is ample room for improvement in antibiotic prescription practices&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In addition to the excessive number of visits to health care facilities&#44; we need to ponder the presence of additional factors that contribute to this frequent and inappropriate use of antibiotics in Spain&#46; And this reflection&#44; based on data and rigorous analyses&#44; must result in the development of improvement measures&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We must remain aware that antimicrobial resistance is considered a threat of such magnitude that it was even addressed in the international G20 summit in Hamburg &#40;July 7&#8211;8&#44; 2017&#41;&#44; where participating nations agreed on the implementation of national action plans to achieve a global European health strategy based on the &#8220;one health&#8221; approach by the end of 2018&#46; Multidrug-resistant microorganisms are responsible for 700&#44;000 deaths a year worldwide&#44; and future projections&#44; should there be no intervention&#44; are not encouraging&#58; in 2050&#44; 10 million people could die due to antimicrobial resistance &#40;compare this with the current rate of 8&#46;2 million deaths&#47;year caused by cancer&#41;&#44; with the associated economic losses from now to that point estimated at 100 trillion dollars&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In Spain&#44; the Agencia Espa&#241;ola de Medicamentos y Productos Sanitarios &#40;Spanish Agency of Medicines and Medical Devices&#41; introduced the Plan Nacional frente a la Resistencia a los Antibi&#243;ticos &#40;National Plan against Antimicrobial Resistance &#91;PRAN&#93;&#44; <a id="intr0015" class="elsevierStyleInterRef" href="http://www.resistenciaantibioticos.es/es">http&#58;&#47;&#47;www&#46;resistenciaantibioticos&#46;es&#47;es</a>&#41; in 2014&#46; The plan involves the participation of a multidisciplinary group of human and veterinary health professionals &#40;including several paediatric scientific societies&#41; working on different strategic lines&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In addition to the obvious responsibility of the prescriber&#44; the specific document on the improvement goals that are a priority in primary care paediatrics developed within the PRAN &#40;<a id="intr0020" class="elsevierStyleInterRef" href="http://www.resistenciaantibioticos.es/es/system/files/content_images/objetivos_de_mejora_prioritarios_ap_pediatria.pdf">http&#58;&#47;&#47;www&#46;resistenciaantibioticos&#46;es&#47;es&#47;system&#47;files&#47;content&#95;images&#47;objetivos&#95;de&#95;mejora&#95;prioritarios&#95;ap&#95;pediatria&#46;pdf</a>&#41; points out factors at play in antibiotic use that go beyond its competences&#46; These include pharmacy dispensation without a prescription&#44; administration by families without medical guidance&#44; large caseloads that prevent adequate communication and health education&#44; lack of control of excessive health care use&#44; the low and random availability in PC clinics of rapid diagnostic tests&#44; lack of access to continuing education and the absence in the electronic health records system of integrated tools to aid clinical decision-making&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The document establishes clear objectives for prescribers&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">To reduce the overall frequency of prescription</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">To reduce prescription for non-bacterial illnesses</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">To improve the appropriateness of prescription in specific diseases</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">To achieve each objective&#44; the authors propose a series of measures&#44; some common to all three&#58; smaller caseloads &#40;to increase the time clinicians spend with each patient&#41;&#44; availability of rapid diagnostic tests in primary care clinics&#44; use of high-yield diagnostic tools &#40;pneumatic otoscopy and&#47;or tympanometry in cases of otitis&#41;&#44; availability of updated data on the specific prevalence of microbes and antimicrobial resistance at the local level&#44; development and integration of systems to guide decision-making in the electronic health records database&#44; and continuing education&#44; tied to productivity and professional development incentives&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Erroneous perceptions about the use and effectiveness of antibiotics still persist in Spain&#46; According to the 2016 Eurobarometer&#44; 48&#37; of the Spanish population believes that antibiotics kill viruses and 45&#37; believes they are effective against the common cold and the flu&#46; These widespread misconceptions probably put pressure on prescribers&#44; but reverting them involves health education&#44; which is the responsibility of health administrations through educational campaigns and also of clinicians through doctor&#47;patient communication &#40;in our case&#44; paediatrician&#47;family&#41; during medical visits&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">There are multiple clinical practice guidelines&#44; care protocols&#44; clinical pathways and consensus documents from scientific societies to guide appropriate antibiotic prescription&#46; We have available an electronic health records system that is generally effective and that could allow the integration of these recommendations or consensus guidelines in the health records&#44; in the form of diagnostic or treatment algorithms and of automated alerts in case of inappropriate prescription&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Lastly&#44; the specific goals dictated by the PRAN in relation to antibiotic prescription in the paediatric primary care setting are&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#46;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Reducing antibiotic prescription in nonbacterial illnesses &#40;colds&#44; laryngitis&#44; non-streptococcal pharyngitis&#44; bronchitis&#41;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Reducing to a minimum antimicrobial treatment of viral pharyngitis&#44; overall and particularly in children aged less than 3 years</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#46;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Reducing the use of macrolides and amoxicillin-clavulanic acid for treatment of tonsillitis</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4&#46;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Reducing the treatment of suspected urinary tract infections that have not been properly confirmed</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">5&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Reducing the use of antibiotics in cases of acute otitis media&#44; considering&#44; in most cases&#44; the approach of watchful waiting with analgesic and anti-inflammatory therapy and postponement of antibiotherapy based on patient progress and&#47;or re-evaluation</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">6&#46;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Avoiding antibiotherapy for treatment of bronchitis&#47;bronchiolitis in young children</p></li></ul></p><p id="par0110" class="elsevierStylePara elsevierViewall">Most of the prescriptions for antibiotherapy for children in Spain are made at the PC level&#44; so we must be aware than in prescribing antibiotics&#44; we may be contributing to the development of antimicrobial resistances or&#44; conversely&#44; that in not prescribing them we may be helping reduce the current rates of antimicrobial resistance&#46; There is much at stake&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a Vera C&#44; Alba&#241;il Ballesteros MR&#46; Prescripci&#243;n de antibi&#243;ticos en pediatr&#237;a de atenci&#243;n primaria&#58; una responsabilidad compartida&#46; An Pediatr &#40;Barc&#41;&#46; 2018&#59;89&#58;195&#8211;196&#46;</p>"
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            0 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prescripci&#243;n de antibi&#243;ticos y realizaci&#243;n de pruebas complementarias en funci&#243;n de la frecuentaci&#243;n y de la fidelizaci&#243;n en Atenci&#243;n Primaria"
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                        0 => array:3 [
                          "colaboracion" => "Grupo de Investigaci&#243;n de la AEPap y Red de pediatras Centinela PAP&#46;en&#46;Red"
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                          "autores" => array:3 [
                            0 => "J&#46;V&#46; Balaguer Mart&#237;nez"
                            1 => "G&#46; del Castillo Aguas"
                            2 => "A&#46; Gallego Iborra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
                        "fecha" => "2018"
                        "volumen" => "89"
                        "paginaInicial" => "197"
                        "paginaFinal" => "204"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic use in children&#58; a cross-national analysis of 6 countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Youngster"
                            1 => "J&#46; Avorn"
                            2 => "V&#46; Belleudi"
                            3 => "A&#46; Cantarutti"
                            4 => "J&#46; D&#237;ez-Domingo"
                            5 => "U&#46; Kirchmayer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpeds.2016.11.027"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2017"
                        "volumen" => "182"
                        "paginaInicial" => "239"
                        "paginaFinal" => "244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28012694"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prescripci&#243;n antibi&#243;tica en infecciones respiratorias agudas en atenci&#243;n pirmaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Malo"
                            1 => "L&#46; Bjerrum"
                            2 => "C&#46; Feja"
                            3 => "M&#46;J&#46; Lallana"
                            4 => "A&#46; Poncel"
                            5 => "M&#46;K&#46; Rabanaque"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
                        "fecha" => "2015"
                        "volumen" => "82"
                        "paginaInicial" => "412"
                        "paginaFinal" => "416"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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Article information
ISSN: 23412879
Original language: English
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