Methods: We reviewed electronic medical records from November 2016 through April 2017 for patients ages 6 to 71 months who were diagnosed with CAP in the CHP ED and CHP-affiliated outpatient sites. Any healthy child with the appropriate ICD-10 code was included. The primary outcome measure was the prescribed antibiotic treatment. We compared children who received first-line CAP treatment, amoxicillin, per the Infectious Disease Society of America (IDSA) guidelines, versus second-line CAP treatments: amoxicillin-clavulanate and cefdinir. We collected any noted justifications for antibiotic choice and compared prescribing practices amongst provider types, including physicians, residents, nurse practitioners and physician assistants. The information was entered into a REDCap database.
Results: A total of 1565 children were included; 52.6% were male, with a mean age of 2.99 years. 351/1565 (22.4%) were diagnosed in the ED. The prescriptions were as follows: amoxicillin (807/1565, 51.6%), amoxicillin-clavulanate (231/1565, 14.8%), cefdinir (156/1565, 10.0%), azithromycin (270/1565, 17.3%), combination therapy (47, 3.0%), and all others (54, 3.5%). In the ED, 232/351 (66.1%) children were prescribed amoxicillin, in contrast to 603/1214 (49.7%) in the outpatient practices (p<0.05). If clinicians did not prescribe first-line therapy, most commonly their reasoning was not provided (402/730, 55.1%). When noted, the most common reasons included: coverage for atypical organisms (115/730, 15.8%), drug allergy (106/730, 14.5%) and recent antibiotic use (55/730, 7.5%).
Conclusion: Providers in the CHP ED were more likely to prescribe first-line therapy of amoxicillin as per IDSA guidelines than their outpatient practice counterparts.
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