Emergency Department Prescribing Patterns for Pharyngitis in Children
Shannon M Flood1,2, Neil M Desai3, Jan E Leonard1,2
1Children's Hospital Colorado, Aurora, CO, USA.
Clinical Pediatrics
|June 6, 2020
Summary
Pediatric emergency departments frequently overprescribe antibiotics for pharyngitis, even for young children. Group A streptococcal pharyngitis diagnosis and antibiotic use remain high, contrary to guidelines.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Pharmacology
Background:
- Pharyngitis is a common pediatric emergency department (ED) diagnosis contributing significantly to antibiotic use.
- Appropriate diagnosis and treatment of group A streptococcal (GAS) pharyngitis are crucial to prevent complications and antimicrobial resistance.
Purpose of the Study:
- To describe ED diagnostic patterns for group A streptococcal (GAS) pharyngitis.
- To analyze antibiotic prescribing patterns for pharyngitis in the ED, with a focus on children under 3 years old.
Main Methods:
- Secondary data analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2010 to 2015.
- Examination of diagnosis and antibiotic treatment for GAS and non-GAS (viral) pharyngitis across all ages, specifically in children <3 years.
Main Results:
- GAS pharyngitis was diagnosed in 29% of pediatric pharyngitis visits, yet 60% of all pharyngitis patients received antibiotics.
- In children <3 years, 20% were diagnosed with GAS pharyngitis, but over half received antibiotics, often broad-spectrum.
- Antibiotic prescribing for pharyngitis remains high relative to GAS prevalence, even in young children, despite guidelines.
Conclusions:
- Antibiotic overuse for pediatric pharyngitis in the ED is prevalent.
- Diagnosis and treatment patterns for GAS pharyngitis in children under 3 persist, contradicting current recommendations.
- There is a need to align ED prescribing practices with evidence-based guidelines for pediatric pharyngitis.
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