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.
J. S. Gerber, None
L. M. Baldwin, None
D. Zerr, None
See more of: Oral Abstract Session