921. Antibiotic Prescribing for Children in Family Medicine Clinics within a Practice Research Network.
Session: Oral Abstract Session: Bacterial Infections and Antimicrobial Stewardship
Friday, October 5, 2018: 9:30 AM
Room: S 156
Background: Family medicine clinics provide care for one third of US children, yet comprehensive data about antibiotic prescribing in this patient population is lacking. We aimed to characterize antibiotic prescribing for children in family medicine clinics.

Methods: A retrospective cohort of patients aged 0-17 years with a visit to a family medicine clinic within the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) Region Practice and Research Network (WPRN) from January 1, 2014 - April 30, 2017 was studied. Patients with complex chronic conditions were excluded. We defined narrow-spectrum antibiotics as penicillin, amoxicillin, 1st generation cephalosporins, sulfonamides, and nitrofurantoin; and broad-spectrum antibiotics otherwise. Based on national guideline recommendations and a previously published hierarchical classification system, we assigned diagnoses to one of three tiers: diagnoses for which antibiotics were (1) almost always indicated (e.g., bacterial pneumonia), (2) may be indicated (e.g., pharyngitis), or (3) generally not indicated (e.g., bronchiolitis/bronchitis).

Results: We studied 20,779 pediatric patients with 97,228 clinic visits. Oral antibiotics were prescribed in 10,922 (11%) of all encounters. The median rate of antibiotic prescribing among providers was 14% (interquartile range: 4.9%-18.5%). Of all antibiotics prescribed, 51% were broad-spectrum agents. Acute respiratory tract infections (ARTIs) accounted for 67% of all antibiotics prescribed. Of the antibiotics prescribed for ARTI, 25% were for diagnoses where antibiotics are generally not indicated. First-line guideline-recommended antibiotics were prescribed in 80% of acute otitis media, 80% of sinusitis, 68% of pharyngitis, and 31% of community acquired pneumonia diagnoses. Azithromycin monotherapy was prescribed in 52% of community acquired pneumonia diagnoses.

Conclusion: Specific targets for improving antimicrobial prescribing within a family medicine practice research network include prescribing of broad-spectrum antibiotics (particularly azithromycin), prescribing for conditions where antibiotics are not indicated, and first-line guideline-recommended prescribing for pharyngitis and community acquired pneumonia.

Nicole Poole, MD, MPH1, Matthew Kronman, MD, MSCE2, Jeffrey S. Gerber, MD, PhD3, Laura-Mae Baldwin, M.D.4 and Danielle Zerr, MD, MPH, FPIDS2, (1)Pediatric Infectious Diseases, Seattle Children's Research Institute, Seattle, WA, (2)Pediatrics, University of Washington, Seattle, WA, (3)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (4)Family Medicine, University of Washington, Seattle, WA

Disclosures:

N. Poole, None

M. Kronman, None

J. S. Gerber, None

L. M. Baldwin, None

D. Zerr, None

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