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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
PubMed

Insights

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.

Keywords:
emergency medicinegeneral pediatricsinfectious diseases

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