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Antibiotic Prescribing for Children in United States Emergency Departments: 2009-2014

Nicole M Poole1,2, Daniel J Shapiro3, Katherine E Fleming-Dutra4

  • 1Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington.

Pediatrics
|January 10, 2019
PubMed

Insights

Children receive nearly 7 million antibiotic prescriptions annually in US emergency departments (EDs), with nonpediatric EDs prescribing more frequently and often inappropriately. Expanding pediatric antibiotic stewardship to nonpediatric EDs is crucial for improving care.

Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Diseases
  • Public Health

Background:

  • Antibiotic prescribing patterns in emergency departments (EDs) for pediatric patients vary significantly.
  • Understanding these variations is critical for optimizing antibiotic use and combating antimicrobial resistance.

Purpose of the Study:

  • To characterize and compare ambulatory antibiotic prescribing for children in US pediatric versus nonpediatric emergency departments.
  • To identify factors associated with guideline-concordant prescribing for common pediatric respiratory infections.

Main Methods:

  • A cross-sectional retrospective study using 2009-2014 National Hospital Ambulatory Medical Care Survey ED data.
  • Analysis of 29 million annual pediatric ED visits, stratified by ED type (pediatric vs. nonpediatric).
  • Multivariable logistic regression to assess predictors of appropriate prescribing for acute otitis media, pharyngitis, and sinusitis.

Main Results:

  • Nonpediatric EDs prescribed antibiotics more frequently (24% vs. 20%) and used broader-spectrum agents more often than pediatric EDs.
  • Approximately 32% of all antibiotic prescriptions (2.1 million annually) were generally not indicated.
  • Nonpediatric EDs showed lower rates of guideline-concordant prescribing for common respiratory conditions (77% vs. 87%).

Conclusions:

  • Children receive nearly 7 million antibiotic prescriptions annually in US EDs, predominantly in nonpediatric settings.
  • Pediatric antibiotic stewardship initiatives must extend to nonpediatric EDs nationwide.
  • Focus areas include reducing unnecessary antibiotic use, limiting macrolide prescriptions, and improving guideline adherence.

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