Methods: Community-dwelling children ages 2-17 years presenting with ARTI symptoms to outpatient pediatric clinics during flu season 2013-2014 were eligible. Demographic data and medical history were collected. Chart review was performed to collect information on initial symptoms, medical conditions, laboratory tests, discharge diagnosis, treatments including whether an antibiotic was prescribed, and follow-up data for the 30 days after enrollment including number of subsequent phone inquiries, return visits, and complications of the original illness and/or treatments. Risk factors for antibiotics prescription were evaluated using logistic regression.
Results: 206 subjects presenting for outpatient treatment of ARTIs were consented and enrolled. Fifty-nine (29%) were prescribed antibiotics; 51 (86%) were for indicated diagnoses, namely Streptococcal pharyngitis (N=34), otitis media (OM) (N=15), and pneumonia (N=2). These discharge diagnoses were the only significant risk factors associated with an antibiotic prescription. Of children prescribed an antibiotic, 17% had follow up phone calls and 16% follow up visits within 30 days related to the initial visit. 2 children with OM were prescribed a 2nd round of antibiotics and 1 developed C. difficilecolitis. Of 147 not prescribed antibiotics, 17% had related phone calls and 17% had related return visits within 30 days. Nine (6%) of these children were prescribed antibiotics within 30 days for new ARTI symptoms, eight were for either a diagnoses of Strep pharyngitis, OM, pneumonia, or sinusitis; one was for flu-like illness.
Conclusion: Among study children 2-17 years with ARTIs in the outpatient setting, antibiotics were overwhelmingly prescribed for appropriate indications: 29% at initial visit and another 6% during the next 30 days. Further reduction in antibiotic use will likely require reductions in diseases for which antibiotics are appropriately prescribed.
Medical student working with a database of a study funded by MedImmune LLC
D. Wyatt, None
Y. Zhu, None
H. K. Talbot, MedImmune LLC: Grant Investigator , Research support