Details:

Alternative Title:
Pediatrics
Personal Author:
Poole, Nicole M. ; Shapiro, Daniel J. ; Fleming-Dutra, Katherine E. ; Hicks, Lauri A. ; Hersh, Adam L. ; ... More +
Poole, Nicole M. ; Shapiro, Daniel J. ; Fleming-Dutra, Katherine E. ; Hicks, Lauri A. ; Hersh, Adam L. ; Kronman, Matthew P. Less -
Description:
Objective:

To characterize and compare ambulatory antibiotic prescribing for children in U.S. pediatric and non-pediatric Emergency Departments (EDs).

Methods:

A cross-sectional retrospective study of patients aged 0–17 years discharged from U.S. EDs was conducted using the 2009–2014 National Hospital Ambulatory Medical Care Survey ED data. We estimated the proportion of ED visits resulting in antibiotic prescriptions, stratified by antibiotic spectrum, class, diagnosis, and ED type (pediatric defined as >75% of visits by patients aged 0–17 years, versus non-pediatric). Multivariable logistic regression was used to determine factors independently associated with first-line, guideline-concordant prescribing for acute otitis media, pharyngitis, and sinusitis.

Results:

In 2009–2014, of the 29 million mean annual ED visits by children, 14% (95% CI: 10–20%) occurred at pediatric EDs. Antibiotics overall were prescribed more frequently in non-pediatric than pediatric ED visits (24% versus 20%, p<0.01). Antibiotic prescribing frequencies were stable over time. Of all antibiotics prescribed, 44% (95% CI: 42–45%) were broad-spectrum, and 32% (95% CI: 30–34%, 2.1 million per year) were generally not indicated. Compared to pediatric EDs, non-pediatric EDs had a higher frequency of prescribing of macrolides (18% versus 8%, p<0.0001) and lower frequency of first-line, guideline-concordant prescribing for the respiratory conditions studied (77% versus 87%, p<0.001).

Conclusions:

Children are prescribed almost 7 million antibiotic prescriptions in EDs annually, primarily in non-pediatric EDs. Pediatric antibiotic stewardship efforts should expand to non-pediatric EDs nationwide, particularly regarding avoidance of antibiotic prescribing for conditions for which antibiotics are not indicated, reducing macrolide prescriptions, and increasing first-line, guideline-concordant prescribing.


Subject:
[+]
Adolescent
Anti-Bacterial Agents
Antimicrobial Stewardship
Article
Child
Child, Preschool
Cross-Sectional Studies
Emergency Service, Hospital
Female
Humans
Inappropriate Prescribing
Infant
Infant, Newborn
Male
Retrospective Studies

Source:
Pediatrics. 143(2)
Pubmed ID:
30622156
Pubmed Central ID:
PMC6581044
Document Type:
Journal Article
Funding:
CC999999/ImCDC/Intramural CDC HHS/United States
Place as Subject:
United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:9f730dff6f184cd5493ff01f1c1f833fcaee746e2d9ea55cabb5360d07b15ffc
File Type:

Supporting Files

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  	NIHMS1010394-supplement-Supplemental-Figure-2.docx	docx
  	NIHMS1010394-supplement-Supplemental_Figure_1.docx	docx

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