Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr;139(4):e20162331.
doi: 10.1542/peds.2016-2331. Epub 2017 Mar 7.

Variability in Antibiotic Prescribing for Community-Acquired Pneumonia

Lori K Handy  1   2 , Matthew Bryan  3   4   5 , Jeffrey S Gerber  3   4   5   6   7 , Theoklis Zaoutis  3   4   5   6   7 , Kristen A Feemster  3   6   7
Affiliations

Variability in Antibiotic Prescribing for Community-Acquired Pneumonia

Lori K Handy et al. Pediatrics. 2017 Apr.

Abstract

Background and objectives: Published guidelines recommend amoxicillin for most children with community-acquired pneumonia (CAP), yet macrolides and broad-spectrum antibiotics are more commonly prescribed. We aimed to determine the patient and clinician characteristics associated with the prescription of amoxicillin versus macrolide or broad-spectrum antibiotics for CAP.

Methods: Retrospective cohort study in an outpatient pediatric primary care network from July 1, 2009 to June 30, 2013. Patients prescribed amoxicillin, macrolides, or a broad-spectrum antibiotic (amoxicillin-clavulanic acid, cephalosporin, or fluoroquinolone) for CAP were included. Multivariable logistic regression models were implemented to identify predictors of antibiotic choice for CAP based on patient- and clinician-level characteristics, controlling for practice.

Results: Of 10 414 children, 4239 (40.7%) received amoxicillin, 4430 (42.5%) received macrolides and 1745 (16.8%) received broad-spectrum antibiotics. The factors associated with an increased odds of receipt of macrolides compared with amoxicillin included patient age ≥5 years (adjusted odds ratio [aOR]: 6.18; 95% confidence interval [CI]: 5.53-6.91), previous antibiotic receipt (aOR: 1.79; 95% CI: 1.56-2.04), and private insurance (aOR: 1.47; 95% CI: 1.28-1.70). The predicted probability of a child being prescribed a macrolide ranged significantly between 0.22 and 0.83 across clinics. The nonclinical characteristics associated with an increased odds of receipt of broad-spectrum antibiotics compared with amoxicillin included suburban practice (aOR: 7.50; 95% CI: 4.16-13.55) and private insurance (aOR: 1.42; 95% CI: 1.18-1.71).

Conclusions: Antibiotic choice for CAP varied widely across practices. Factors unlikely related to the microbiologic etiology of CAP were significant drivers of antibiotic choice. Understanding drivers of off-guideline prescribing can inform targeted antimicrobial stewardship initiatives.

PubMed Disclaimer

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Networkwide cases of CAP resulting in antibiotic prescriptions of interest.
FIGURE 2
FIGURE 2
Predicted probability of macrolide prescribing. Clinics are ordered by their predicted probability of prescription of a macrolide (lowest to highest). Urban clinics are circled. Predicted probabilities were generated based on the multivariate logistic regression model with clinic type (urban or suburban) removed from the model.
FIGURE 3
FIGURE 3
Predicted probability of broad-spectrum prescribing. Clinics are ordered by their predicted probability of prescription of a broad-spectrum antibiotic (lowest to highest). Urban clinics are circled. Predicted probabilities were generated based on the multivariate logistic regression model with clinic type (urban or suburban) removed from the model.
See this image and copyright information in PMC

Comment in

References

    1. Kronman MP, Hersh AL, Feng R, Huang YS, Lee GE, Shah SS. Ambulatory visit rates and antibiotic prescribing for children with pneumonia, 1994-2007. Pediatrics. 2011;127(3):411–418 - PMC - PubMed
    1. Bradley JS, Byington CL, Shah SS, et al. ; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America . Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):617–630 - PMC - PubMed
    1. Gerber JS, Prasad PA, Fiks AG, et al. . Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA. 2013;309(22):2345–2352 - PubMed
    1. Brogan TV, Hall M, Williams DJ, et al. . Variability in processes of care and outcomes among children hospitalized with community-acquired pneumonia. Pediatr Infect Dis J. 2012;31(10):1036–1041 - PMC - PubMed
    1. Queen MA, Myers AL, Hall M, et al. . Comparative effectiveness of empiric antibiotics for community-acquired pneumonia. Pediatrics. 2014;133(1). Available at: www.pediatrics.org/cgi/content/full/133/1/e23 - PMC - PubMed

Substances