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. 2019 Feb;143(2):e20181056.
doi: 10.1542/peds.2018-1056. Epub 2019 Jan 8.

Antibiotic Prescribing for Children in United States Emergency Departments: 2009-2014

Nicole M Poole  1   2 , Daniel J Shapiro  3 , Katherine E Fleming-Dutra  4 , Lauri A Hicks  4 , Adam L Hersh  5 , Matthew P Kronman  1
Affiliations

Antibiotic Prescribing for Children in United States Emergency Departments: 2009-2014

Nicole M Poole et al. Pediatrics. 2019 Feb.

Abstract

: media-1vid110.1542/5972296744001PEDS-VA_2018-1056Video Abstract OBJECTIVES: To characterize and compare ambulatory antibiotic prescribing for children in US pediatric and nonpediatric emergency departments (EDs).

Methods: A cross-sectional retrospective study of patients aged 0 to 17 years discharged from EDs in the United States was conducted by using the 2009-2014 National Hospital Ambulatory Medical Care Survey ED data. We estimated the proportion of ED visits resulting in antibiotic prescriptions, stratified by antibiotic spectrum, class, diagnosis, and ED type ("pediatric" defined as >75% of visits by patients aged 0-17 years, versus "nonpediatric"). Multivariable logistic regression was used to determine factors independently associated with first-line, guideline-concordant prescribing for acute otitis media, pharyngitis, and sinusitis.

Results: In 2009-2014, of the 29 million mean annual ED visits by children, 14% (95% confidence interval [CI]: 10%-20%) occurred at pediatric EDs. Antibiotics overall were prescribed more frequently in nonpediatric than pediatric ED visits (24% vs 20%, P < .01). Antibiotic prescribing frequencies were stable over time. Of all antibiotics prescribed, 44% (95% CI: 42%-45%) were broad spectrum, and 32% (95% CI: 30%-34%, 2.1 million per year) were generally not indicated. Compared with pediatric EDs, nonpediatric EDs had a higher frequency of prescribing macrolides (18% vs 8%, P < .0001) and a lower frequency of first-line, guideline-concordant prescribing for the respiratory conditions studied (77% vs 87%, P < .001).

Conclusions: Children are prescribed almost 7 million antibiotic prescriptions in EDs annually, primarily in nonpediatric EDs. Pediatric antibiotic stewardship efforts should expand to nonpediatric EDs nationwide, particularly regarding avoidance of antibiotic prescribing for conditions for which antibiotics are not indicated, reducing macrolide prescriptions, and increasing first-line, guideline-concordant prescribing.

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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:. Percent of antibiotic visits by antibiotic class for ED visits by children, by ED type, United States, 2009–2014.
Shading represents antibiotic class: dark grey are penicillins, light grey are cephalosporins, grey/white checkered are macrolides, black/white dotted are sulfonamides, white/grey diamonds are clindamycin (lincomycin derivative), and lightest grey are all other antibiotics. *P≤0.05 in comparison of non-pediatric versus pediatric ED. **Percentages sum to >100% because of co-prescribing at some visits.
Figure 2:
Figure 2:. Percent of antibiotic visits by antibiotic class for ED visits by children over time, United States, 2009–2014.
*Antibiotic visits were defined as visits in which antibiotics were mentioned as continued, administered, or prescribed. **2-year increments used to assess change in antibiotic prescriptions over time. No significant change in percentages over the study period.
See this image and copyright information in PMC

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References

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