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. 2025 Aug 1;41(8):628-634.
doi: 10.1097/PEC.0000000000003395. Epub 2025 Apr 14.

Patient Age and Antibiotic Formulation Administration in the Pediatric Emergency Department

Sriram Ramgopal  1   2   3 , Marc Rosenman  2   3   4 , Elizabeth R Alpern  1   2   3 , Todd A Florin  1   2   3 , Kenneth A Michelson  1   2   3
Affiliations

Patient Age and Antibiotic Formulation Administration in the Pediatric Emergency Department

Sriram Ramgopal et al. Pediatr Emerg Care. .

Abstract

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.

Keywords: antibiotic prescribing; formulation; medication adherence.

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Conflict of interest statement

Disclosure: S.R. is supported by the National Institutes of Health/National Heart, Lung, and Blood Institute (K01HL169921). The remaining authors declare no conflict of interest.

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