Optimal Pediatric Outpatient Antibiotic Prescribing
Brittany J Lehrer1, Glodi Mutamba2, Katie A Thure2
1Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA Network Open
|October 3, 2024
Summary
Less than one-third of pediatric outpatient antibiotic prescriptions in Tennessee were optimal for choice and duration. Interventions should focus on reducing unnecessary prescriptions for less severe conditions and improving guideline adherence for common infections.
Area of Science:
- Pediatric infectious disease
- Antimicrobial stewardship
- Health services research
Background:
- Half of pediatric outpatient antibiotic prescriptions in the US are unnecessary or inappropriate.
- Limited data exists on the appropriateness of antibiotic prescribing for children in outpatient settings.
Purpose of the Study:
- To determine the percentage of pediatric outpatient antibiotic prescriptions that align with national guidelines for first-line antibiotic choice and duration.
- To identify factors associated with optimal antibiotic prescribing in pediatric populations.
Main Methods:
- A cross-sectional study analyzed antibiotic prescriptions for patients under 20 years old in Tennessee from January to December 2022.
- Prescriptions were categorized by diagnosis tiers (1-3) and compared against established national guidelines for choice and duration.
- Multivariable logistic regression was used to assess associations between optimal prescribing and patient/clinician factors.
Main Results:
- Out of 506,633 antibiotic prescriptions, only 31.4% were optimal for both choice and duration.
- Optimal prescribing rates varied by diagnosis, with Acute Otitis Media (AOM) and pharyngitis showing higher rates (67.3% and 55.9% optimal choice, respectively).
- Community-acquired pneumonia prescriptions frequently exceeded recommended 5-day durations (only 5.7% optimal). Younger age and lower social vulnerability were associated with more optimal antibiotic choice.
Conclusions:
- Less than one-third of pediatric outpatient antibiotic prescriptions in Tennessee met optimal choice and duration guidelines.
- Targeted stewardship interventions are needed, including reducing prescriptions for tier 3 diagnoses, improving AOM and pharyngitis prescribing, educating on pneumonia treatment duration, and promoting optimal prescribing in underserved areas.
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