Antibiotic Prescribing in Outpatient Children: A Cohort From a Clinical Data Warehouse

Area of Science:

• Pediatric Infectious Diseases
• Pharmacoepidemiology
• Health Informatics

Background:

• Antibiotic (ab) resistance is a growing global health concern.
• Understanding pediatric antibiotic prescribing patterns is crucial for antimicrobial stewardship.
• Comorbid conditions may influence antibiotic use in children.

Purpose of the Study:

• To characterize antibiotic prescriptions in a pediatric outpatient setting.
• To identify factors associated with antibiotic prescribing in children.
• To evaluate the utility of a clinical data warehouse for antimicrobial stewardship.

Main Methods:

• Retrospective cohort study using a data warehouse (Massachusetts Health Disparities Repository).
• Analysis of outpatient visits and antibiotic prescriptions over a 3-year period.
• Stratification by comorbid conditions, demographics, and clinical indication.

Main Results:

• 15,208 children and nearly 120,000 outpatient visits were analyzed.
• Approximately one-third of children had comorbid conditions, most commonly asthma.
• First-line penicillins and macrolides accounted for 70% of ~30,000 antibiotic prescriptions.
• Children with comorbidities received more antibiotic prescriptions (54.3/100 child-years vs. 38.8).
• Higher antibiotic use was observed for urinary tract infections, otitis, and lower respiratory tract infections, especially in comorbid children and those under 2 years old.
• Antibiotic prescriptions were associated with younger age, emergency room visits, comorbid conditions, and acute infections.

Conclusions:

• Clinical data warehouses are valuable tools for assessing antibiotic prescribing patterns.
• Data-driven insights can inform the design of targeted antimicrobial stewardship programs.
• Optimizing antibiotic use in children, especially those with comorbidities, is essential to combat resistance.