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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Patient Age and Antibiotic Formulation Administration in the Pediatric Emergency Department
Sriram Ramgopal1,2,3, Marc Rosenman2,3,4, Elizabeth R Alpern1,2,3
1Department of Pediatrics, Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine.
Insights
Pediatric emergency departments see age-related differences in oral antibiotic formulations. Tablet/capsule use surpasses suspensions around age 14, informing prescribing for better adherence.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Clinical Pharmacy
Background:
- Oral antibiotics are frequently prescribed in the United States.
- Formulation choice (suspension vs. tablet/capsule) can impact medication adherence and treatment effectiveness in children.
Purpose of the Study:
- To describe the distribution of oral antibiotic formulation administration among children in the emergency department (ED).
- To identify the age at which tablet/capsule formulations become more common than suspensions for pediatric patients.
Main Methods:
- Retrospective single-center study of children (<18 years) discharged from a pediatric ED between 2016-2022.
- Included encounters prescribed 7 common oral antibiotics in suspension or tablet/capsule forms, excluding specific patient groups.
- Analyzed antibiotic administration and prescription data to determine formulation preference shifts by age.
Main Results:
- 12,900 eligible encounters were analyzed, with common diagnoses including ear, throat, and skin infections.
- Across all antibiotics administered in the ED, the age threshold where tablet/capsule use exceeded suspensions was 14 years.
- Specific age thresholds varied by antibiotic, ranging from 10 years for trimethoprim-sulfamethoxazole to 16 years for amoxicillin.
Conclusions:
- Significant age-related differences in oral antibiotic formulation preferences exist in pediatric ED settings.
- These findings can guide prescribing practices to enhance medication adherence and treatment outcomes.
- Understanding formulation distribution is crucial for clinical decision support, shared decision-making, and managing medication shortages.
Objective:
Oral antibiotics are the most prescribed medication in the United States. We sought to describe the distribution of oral antibiotic formulation administration among children in the emergency department (ED).
Methods:
We performed a retrospective single-center study of children presenting to a pediatric ED. We included encounters for children (<18 years) discharged from the ED between 2016 and 2022 and prescribed one of 7 common antibiotics in oral suspension or tablet/capsule forms, excluding children with an enteral feeding tube or complex neuromuscular conditions. We analyzed encounters for children administered an antibiotic in the ED and antibiotic prescriptions. We determined the age at which the proportion of children given a tablet or capsule equaled or exceeded the proportion of those given a suspension.
Results:
We identified 12,900 eligible encounters (median age: 4.3 years, interquartile range: 1.7 to 8.1 years; 51.5% boys). The most common diagnoses were infectious ear disorders (22.6%), infectious mouth and throat disorders (9.1%), infectious skin, dermatologic and soft tissue disorders (6.6%), and infectious nose and sinus disorders (6.2%). For all antibiotics administered in the ED (n = 3809 encounters; 52.6% for amoxicillin), the age threshold at which more children were prescribed the tablet/capsule than the suspension formulation was 14 years. This threshold for each antibiotic was 16 years for amoxicillin, 13 years for amoxicillin-clavulanate, 11 years for azithromycin, 14 years for cefdinir, 12 years for cephalexin, 11 years for clindamycin, and 10 years for trimethoprim-sulfamethoxazole. Findings were similar for encounters discharged from the ED with an antibiotic prescription.
Conclusions:
We identified age-related differences in antibiotic formulations in a pediatric ED. These findings can inform prescribing practices to optimize medication adherence and treatment effectiveness through clinical decision support and shared decision-making and may be especially useful during periods of formulation shortages or when planning for clinical research.
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