Guideline Adherence and Antibiotic Utilization by Community Pediatricians, Private Urgent Care Centers, and a...

Area of Science:

• Pediatric infectious diseases
• Antimicrobial stewardship
• Health services research

Background:

• Pediatric antibiotic prescriptions are increasingly common in diverse ambulatory settings.
• Urgent care centers (UCCs) and emergency departments (EDs) are growing sources of these prescriptions.
• Variations in prescribing practices exist across different healthcare settings.

Purpose of the Study:

• To analyze pediatric antibiotic utilization for common infections across primary care offices, UCCs, and a pediatric ED.
• To compare antibiotic prescribing patterns with medical society practice guidelines.
• To estimate the potential for antibiotic stewardship interventions.

Main Methods:

• Retrospective analysis of 2358 eligible pediatric visits for pharyngitis, otitis media, sinusitis, pneumonia, and upper respiratory infections.
• Data collected from 11 primary care offices, 2 independent UCCs, and 1 pediatric ED in Western New York.
• Evaluation of antibiotic use against established clinical practice guidelines.

Main Results:

• Urgent care centers accounted for 38% of study-related visits.
• 26% of pediatric pharyngitis cases received antibiotics without clear evidence of bacterial infection.
• Guideline-recommended first-line agents were used in only 58% (pharyngitis) and 63% (otitis media) of treated cases at primary care offices and UCCs.
• An estimated 9855 to 12 045 avoidable antibiotic courses and 8030 non-guideline courses are prescribed annually across the studied sites.

Conclusions:

• Significant opportunities exist to optimize antibiotic prescribing in pediatric outpatient settings.
• Improving adherence to clinical guidelines can reduce unnecessary antibiotic use.
• Enhanced antibiotic stewardship programs are crucial for pediatric care.