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.
A. L. Hersh,
D. Liu, None
M. Zhang, None
K. Madaras-Kelly, None
M. Samore, None
L. Hicks, None
K. Fleming-Dutra, None
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