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Published on: March 16, 2018
Prescribing and Dispensing Delayed Antibiotics for Pediatric Patients with Otitis Media and Pharyngitis
Shobhitha Balasubramaniam1, Melanie MacInnis2, Katrina Hurley3
1, HBSc, PharmD, was, at the time this study was conducted, a student in the Doctor of Pharmacy program at Dalhousie University, Halifax, Nova Scotia. She has now graduated.
Insights
Delayed antibiotic prescriptions for pediatric acute otitis media and pharyngitis were often filled early. However, most caregivers adhered to guidance, suggesting this strategy can reduce antibiotic overuse.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Disease Management
- Pharmacoeconomics
Background:
- Antibiotic overuse contributes to antimicrobial resistance.
- Delayed antibiotic prescriptions are a strategy to reduce antibiotic use for acute otitis media (AOM) and pharyngitis.
- Understanding adherence to delayed prescriptions is crucial for evaluating this strategy.
Purpose of the Study:
- To analyze antibiotic prescribing patterns in a pediatric emergency department (PED) for AOM and pharyngitis.
- To determine the rate of premature dispensing of delayed antibiotic prescriptions by community pharmacies.
- To assess caregiver adherence to delayed antibiotic prescription guidelines.
Main Methods:
- Retrospective chart review and linkage with provincial administrative data on dispensed prescriptions.
- Inclusion of pediatric patients diagnosed with AOM or pharyngitis and discharged with an antibiotic prescription.
- Descriptive analysis of prescription dispensing timelines and adherence.
Main Results:
- Over half of patients with AOM or pharyngitis received an antibiotic prescription (53.3%).
- Delayed prescriptions were issued in 21.2% of encounters.
- Less than half (40.4%) of delayed prescriptions were dispensed within 7 days; 30.1% were filled within 48 hours, and 16.9% were dispensed earlier than advised.
Conclusions:
- Caregivers largely adhered to prescriber guidance for delayed antibiotic prescriptions.
- The delayed prescription strategy shows potential for reducing unnecessary antibiotic consumption.
- Further research may explore factors influencing premature dispensing and optimize adherence.
Background:
Providing patients with a delayed prescription for antibiotics to treat acute otitis media (AOM) or pharyngitis may result in decreased antibiotic use.
Objectives:
To characterize antibiotic prescribing for patients discharged from a pediatric emergency department (PED) with AOM or pharyngitis and to determine the percentage of delayed antibiotic prescriptions dispensed prematurely by a community pharmacy.
Methods:
This study was completed by linking provincial administrative data on prescriptions dispensed from community pharmacies and a retrospective chart review at a single PED. The study included any pediatric patient who was seen in the PED between March 2019 and February 2021, given a diagnosis of AOM or pharyngitis, and discharged with a prescription for an antibiotic. Patient data were collected from scanned medical records. The chart review was linked to records for dispensed antibiotics in the provincial drug information system. Results were summarized and reported descriptively.
Results:
A total of 1569 (53.3%) of the 2945 patients seen in the PED with the diagnoses of interest received a prescription for an antibiotic. Delayed prescriptions were given in 21.2% (332/1569) of these encounters. An antibiotic was dispensed within 7 days of the PED visit for fewer than half of the patients (40.4%, 134/332) who received a delayed prescription. About a third of caregivers filled delayed prescriptions within 48 hours (30.1%, 100/332), and 16.9% (43/254) did so earlier than advised.
Conclusion:
Caregivers who were given a discharge prescription for a delayed antibiotic generally adhered to guidance provided by prescribers and waited to fill the prescription. This strategy may reduce overuse of antibiotics.
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