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Published on: August 30, 2018
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Variation in Antibiotic Prescribing Across a Pediatric Primary Care Network
Jeffrey S Gerber1, Priya A Prasad2, A Russell Localio3
1Divisions of Infectious Diseases The Center for Pediatric Clinical Effectiveness Departments of Pediatrics Biostatistics and Epidemiology Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Journal of the Pediatric Infectious Diseases Society
|November 20, 2015
Summary
Antibiotic prescribing for pediatric respiratory infections varies widely between practices, even after accounting for patient factors. This highlights significant opportunities for improving antimicrobial stewardship in outpatient settings.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Health services research
Background:
- Outpatient respiratory tract infections are a leading cause of antibiotic prescriptions in children.
- Previous research indicates antibiotic overuse, but lacks detailed data on practice-level variability.
Purpose of the Study:
- To investigate the variability in antibiotic prescribing for pediatric acute respiratory tract infections across different outpatient practices.
- To identify potential determinants of this prescribing variability.
Main Methods:
- Retrospective cohort study of 399,793 acute visits to 25 pediatric practices (222 clinicians) in 2009.
- Data extracted from electronic health records, including diagnoses, medications, and patient demographics.
- Analysis adjusted for patient factors and clinician clustering to compare practice-level prescribing rates.
Main Results:
- 28% of acute visits resulted in antibiotic prescriptions.
- Antibiotic prescribing rates varied from 18% to 36% across practices, with broad-spectrum antibiotic use ranging from 15% to 58%.
- Significant practice-level variation was observed in diagnoses and broad-spectrum antibiotic prescribing for common infections like otitis media, sinusitis, pharyngitis, and pneumonia.
Conclusions:
- Substantial unexplained variability exists in antibiotic prescribing for common pediatric infections among outpatient practices.
- Patient-specific factors do not account for this observed prescribing variation.
- These findings underscore the need for targeted antimicrobial stewardship interventions in pediatric outpatient settings.
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