170. Characterization of Appropriate Antibiotic Prescribing for Pediatric Respiratory Tract Infections: Setting the Stage for Stewardship
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions in Pediatric Populations
Thursday, October 4, 2018
Room: S Poster Hall

Background: Inappropriate antibiotic use includes prescribing for antibiotic inappropriate diagnoses and use of broad-spectrum instead of narrow-spectrum therapies and contributes to adverse events and antibiotic resistance. To guide the design and implementation of antibiotic stewardship interventions in a network of pediatric clinics, we sought to characterize appropriate antibiotic prescribing for children diagnosed with uncomplicated respiratory infections.

Methods: Retrospective cohort study of visits by children to one of 31 primary care or 6 urgent care clinics in a university healthcare system between Jan 1, 2016 and Dec 31, 2017. Two outcomes were used to characterize antibiotic prescribing: (1) percentage of antibiotic inappropriate diagnoses (bronchitis, bronchiolitis, upper respiratory infection) that were prescribed an antibiotic; (2) percentage of visits with a diagnosis for acute otitis media (AOM), sinusitis or pharyngitis prescribed first-line recommended antibiotics (amoxicillin or penicillin). Children with a documented penicillin allergy or antibiotic prescriptions in the previous 30 days were excluded. Chi-square tests were used to compare prescribing between settings.  

Results: Among 117279 total visits examined, 16760 (14%) were for antibiotic inappropriate diagnoses, 5912 (5%) for AOM, 844 (1%) for sinusitis and 4912 (4%) for pharyngitis. Only 3% (95% CI: 2.9-3.4) of antibiotic inappropriate diagnoses were prescribed antibiotics. The percent of visits for AOM, sinusitis, and pharyngitis prescribed first-line antibiotics ranged from 27% (95% CI: 21-33) for sinusitis in urgent care to 91% (95% CI: 90-92) for pharyngitis in urgent care (Figure). Differences in appropriate prescribing by setting were observed for AOM (p<0.01) and sinusitis (p<0.01).

Conclusion: In this network of pediatric practices, we found minimal evidence of unnecessary antibiotic use for respiratory infections but substantial underuse of first-line therapy for sinusitis, especially in urgent care settings.  Stewardship interventions designed to reinforce existing practices for antibiotic-inappropriate conditions and promote greater use of appropriate first-line therapies are planned for this setting. 

Adam L. Hersh, MD, PhD1, Emily Thorell, MD, MSCI2, Diane Liu, Liu3, Mingyuan Zhang, MS3, Karl Madaras-Kelly, PharmD, MPH4, Matthew Samore, MD, FSHEA5, Lauri Hicks, DO6 and Katherine Fleming-Dutra, MD7, (1)University of Utah School of Medicine, Salt Lake City, UT, (2)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (3)University of Utah, Salt Lake City, UT, (4)Pharmacy Service, Boise Veterans Affairs Medical Center, Boise, ID, (5)University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, (6)Centers for Disease Control and Prevention, Atlanta, GA, (7)CDC, Atlanta, GA

Disclosures:

A. L. Hersh, None

E. Thorell, None

D. Liu, None

M. Zhang, None

K. Madaras-Kelly, None

M. Samore, None

L. Hicks, None

K. Fleming-Dutra, None

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