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National ambulatory antibiotic prescribing patterns for pediatric urinary tract infection, 1998-2007
Hillary L Copp1, Daniel J Shapiro, Adam L Hersh
1Department of Urology, University of California, San Francisco, San Francisco, CA 94130, USA. copphl@urology.ucsf.edu
Insights
Pediatricians often prescribe broad-spectrum antibiotics for urinary tract infections (UTIs), particularly for young children. Opportunities exist to promote narrower antibiotic choices for most pediatric UTIs.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
Background:
- Pediatric urinary tract infections (UTIs) are common.
- Antibiotic prescribing patterns for pediatric UTIs require investigation to ensure appropriate use.
Purpose of the Study:
- To investigate ambulatory antibiotic use patterns for pediatric UTIs.
- To identify factors associated with broad-spectrum antibiotic prescribing in children.
Main Methods:
- Analysis of UTI antibiotic prescriptions for children (<18 years) from 1998-2007 using national survey data.
- Classification of broad-spectrum antibiotics (amoxicillin-clavulanate, quinolones, macrolides, cephalosporins).
- Multivariable logistic regression to identify predictors of broad-spectrum antibiotic use.
Main Results:
- Antibiotics were prescribed in 70% of pediatric UTI visits; trimethoprim-sulfamethoxazole was most common.
- Broad-spectrum antibiotics were used one-third of the time, with no overall increase.
- Third-generation cephalosporin use doubled (12% to 25%).
- Predictors for broad-spectrum antibiotic use included younger age (<2 years), female sex, and fever (≥100.4°F).
Conclusions:
- Broad-spectrum antibiotics are frequently prescribed for pediatric UTIs, especially in febrile infants.
- Increased use of third-generation cephalosporins highlights potential for more judicious prescribing.
- Most pediatric UTIs can be treated with narrower-spectrum antibiotics.
Objective:
The goal of this study was to investigate patterns of ambulatory antibiotic use and to identify factors associated with broad-spectrum antibiotic prescribing for pediatric urinary tract infections (UTIs).
Methods:
We examined antibiotics prescribed for UTIs for children aged younger than 18 years from 1998 to 2007 using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Amoxicillin-clavulanate, quinolones, macrolides, and second- and third-generation cephalosporins were classified as broad-spectrum antibiotics. We evaluated trends in broad-spectrum antibiotic prescribing patterns and performed multivariable logistic regression to identify factors associated with broad-spectrum antibiotic use.
Results:
Antibiotics were prescribed for 70% of pediatric UTI visits. Trimethoprim-sulfamethoxazole was the most commonly prescribed antibiotic (49% of visits). Broad-spectrum antibiotics were prescribed one third of the time. There was no increase in overall use of broad-spectrum antibiotics (P = .67); however, third-generation cephalosporin use doubled from 12% to 25% (P = .02). Children younger than 2 years old (odds ratio: 6.4 [95% confidence interval: 2.2-18.7, compared with children 13-17 years old]), females (odds ratio: 3.6 [95% confidence interval: 1.6-8.5]), and temperature ≥ 100.4°F (odds ratio: 2.9 [95% confidence interval: 1.0-8.6]) were independent predictors of broad-spectrum antibiotic prescribing. Race, physician specialty, region, and insurance status were not associated with antibiotic selection.
Conclusions:
Ambulatory care physicians commonly prescribe broad-spectrum antibiotics for the treatment of pediatric UTIs, especially for febrile infants in whom complicated infections are more likely. The doubling in use of third-generation cephalosporins suggests that opportunities exist to promote more judicious antibiotic prescribing because most pediatric UTIs are susceptible to narrower alternatives.
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