Related Experiment Video
Updated: May 27, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Antibiotic prescribing in ambulatory pediatrics in the United States
Adam L Hersh1, Daniel J Shapiro, Andrew T Pavia
1Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA. adam.hersh@hsc.utah.edu
Insights
Broad-spectrum antibiotic prescribing is common in pediatric care, often for conditions like viral respiratory infections where they offer no benefit. This inappropriate use contributes to antibiotic resistance and unnecessary costs.
Area of Science:
- Pediatric infectious disease epidemiology
- Antimicrobial stewardship
- Public health policy
Background:
- Antibiotics are frequently prescribed for pediatric conditions, including viral respiratory infections, where they lack therapeutic benefit.
- Increasing use of broad-spectrum antibiotics incurs costs and drives antimicrobial resistance.
Purpose of the Study:
- To conduct a national analysis of antibiotic prescribing patterns in pediatric ambulatory care.
- To examine antibiotic classes and diagnostic categories, focusing on broad-spectrum antibiotic prescribing factors.
Main Methods:
- Utilized data from the National Ambulatory and National Hospital Ambulatory Medical Care surveys (2006-2008).
- Estimated antibiotic and broad-spectrum antibiotic prescribing rates by diagnostic category for patients under 18.
- Employed multivariable logistic regression to identify factors associated with broad-spectrum antibiotic use.
Main Results:
- Antibiotics were prescribed in 21% of pediatric ambulatory visits, with 50% being broad-spectrum (commonly macrolides).
- Respiratory conditions represented over 70% of visits involving antibiotic and broad-spectrum antibiotic prescriptions.
- Over 10 million annual visits for respiratory conditions received antibiotics inappropriately; factors linked to broad-spectrum use included these conditions, younger age, Southern region visits, and private insurance.
Conclusions:
- Broad-spectrum antibiotic prescribing is prevalent and often inappropriate in pediatric ambulatory settings.
- Findings highlight key areas for targeted antibiotic stewardship interventions in ambulatory care, including specific regions, diagnoses, and patient demographics.
Background:
Antibiotics are commonly prescribed for children with conditions for which they provide no benefit, including viral respiratory infections. Broad-spectrum antibiotic use is increasing, which adds unnecessary cost and promotes the development of antibiotic resistance.
Objective:
To provide a nationally representative analysis of antibiotic prescribing in ambulatory pediatrics according to antibiotic classes and diagnostic categories and identify factors associated with broad-spectrum antibiotic prescribing.
Patients And Methods:
We used the National Ambulatory and National Hospital Ambulatory Medical Care surveys from 2006 to 2008, which are nationally representative samples of ambulatory care visits in the United States. We estimated the percentage of visits for patients younger than 18 years for whom antibiotics were prescribed according to antibiotic classes, those considered broad-spectrum, and diagnostic categories. We used multivariable logistic regression to identify demographic and clinical factors that were independently associated with broad-spectrum antibiotic prescribing.
Results:
Antibiotics were prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum, most commonly macrolides. Respiratory conditions accounted for >70% of visits in which both antibiotics and broad-spectrum antibiotics were prescribed. Twenty-three percent of the visits in which antibiotics were prescribed were for respiratory conditions for which antibiotics are not clearly indicated, which accounts for >10 million visits annually. Factors independently associated with broad-spectrum antibiotic prescribing included respiratory conditions for which antibiotics are not indicated, younger patients, visits in the South, and private insurance.
Conclusions:
Broad-spectrum antibiotic prescribing in ambulatory pediatrics is extremely common and frequently inappropriate. These findings can inform the development and implementation of antibiotic stewardship efforts in ambulatory care toward the most important geographic regions, diagnostic conditions, and patient populations.
More Related Videos
12:18Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
09:17A Robust Pneumonia Model in Immunocompetent Rodents to Evaluate Antibacterial Efficacy against S. pneumoniae, H. influenzae, K. pneumoniae, P. aeruginosa or A. baumannii
Published on: January 2, 2017
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:29Drug Dosing: Infants and Children
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care