Objective: To evaluate variation in antibiotic prescribing between pediatric and non-pediatric providers for common upper respiratory illnesses.
Methods: Patient encounters for children aged <18 years from a regional health care system were identified. Electronic medical records from 2011-2016 were extracted for diagnoses of upper respiratory infection (URI), pharyngitis, acute otitis media (AOM), and sinusitis. Encounters with competing medical diagnoses, recent hospitalization, and antibiotic prescriptions within 30 days were excluded. Adherence to antibiotic guidelines was assessed by provider training (pediatric, non-pediatric physicians, and advance practice providers (APP)). Additional factors assessed included clinic or urgent care setting, calendar year, and patient’s age, gender, insurance status, and number of sick visits in the prior year.
Results: Across 6 years, 141,361 visits were examined: 43,914 for URI, 43,701 for pharyngitis, 43,925 for AOM, and 9,821 for sinusitis. Pediatricians were more likely than APPs and non-pediatric providers to have guideline-concordant prescribing for pharyngitis (pediatricians 66.7 (54.5, 77.0)%, non-pediatricians 49.1 (36.3, 62.0)%, APPs 52.2(39.4, 64.7)%, p<0.0001 ) and sinusitis (pediatricians 70.8(53.8, 83.4)%, non-pediatricians 63.3(46.8, 77.2)%, APPs 62.1(45.1, 76.5)%, p=0.48) and to withhold antibiotics for URI than APPs and non-pediatric providers (pediatricians 86.6(81.2, 90.6)%, non-pediatricians 80.8(73.0, 86.8)%, APPs 76.8(68.4, 83.5)%, p<0.0001). Pediatricians were less likely to prescribe antibiotics for pharyngitis without a positive Group A Streptococcus test than APPs and non-pediatric providers (pediatricians 15.1(10.4, 21.6)%, non-pediatricians 29.4(20.8, 39.6)%, APPs 27.2(19.3, 36.9)%, p<0.0001). First-line antibiotic prescribing for pharyngitis and AOM did not differ between provider specialties. A trend toward more guideline-concordant prescribing was seen for pharyngitis and sinusitis over the study period.
Conclusion: Pediatricians were more likely to adhere to guidelines for pediatric acute respiratory infections. Pediatric antibiotic stewardship efforts should also target non-pediatricians.
H. M. Frost,
B. Chow, None