Objectives: The primary objective of this study was to determine the proportion of children with a reported BLA who received second-line antimicrobials (as determined by hospital empiric antibiotic guidelines). The secondary objective was to identify patient characteristics associated with receiving second-line antibiotics.
Methods: A one-year retrospective cohort study was undertaken at the Hospital for Sick Children. We reviewed the characteristics and management of patients with a reported BLA who received antibiotics from January to December 2016.
Results: Of the 16 224 admissions in 2016, 206 patients with a reported BLA received antibiotics. Among these patients, the median age was 7.9 years (IQR 4.0,12.8) and the majority of patients had at least one medical condition (n=120, 59.3%), including 27 children with complex medical or genetic conditions (13.1%). Penicillin (n=86, 41.8%) and amoxicillin (n=70, 33.9%) were the most commonly reported allergens. Non-severe rashes were the most commonly reported allergic reactions (n=158, 73.1%). Ninety four patients (46%; 95% CI (0.39,0.52) received second-line therapy. After adjusting for age and sex, the odds of receiving a second-line antibiotic were increased in patients with any underlying medical condition (OR = 2.45, 95% CI 1.32-4.56), had a reported allergic reaction that was deemed high-risk (i.e. anaphylaxis, respiratory or systemic symptoms, severe rashes) (OR = 2.61, 95% CI 1.11-6.11) or who received antibiotics for surgical prophylaxis (OR = 3.30, 95% CI 1.44-7.54).
Conclusion: Almost half of pediatric patients with a reported BLA received a second-line antibiotic when compared to hospital empiric antibiotic guidelines. There is a need for a systematic approach to evaluating reported BLA in order to promote judicious prescribing habits.
K. Timberlake, None
A. Atkinson, None
M. Science, None
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