Ambulatory cephalosporin prescribing practices at a freestanding children’s hospital network

Abstract

Antibiotics are prescribed in ∼21% of pediatric ambulatory visits nationally; of those, 16% are broad-spectrum cephalosporins (second-fourth generation). 1 Broad-spectrum cephalosporins are rarely recommended as first-line therapy for common pediatric infections, except in some instances of penicillin allergy. 2,3 Cefdinir in particular is frequently prescribed despite its less optimal pharmacokinetics and pharmacodynamics. 4,5 The overprescription of broad-spectrum cephalosporins leads to the development of antimicrobial resistance, unnecessary cost, and adverse side effects. 6 Prior studies looking at antibiotic use often solely use electronic medical record (EMR) codes to analyze data; however, limitations exist with this method, and more robust data can be obtained through chart review. In this study, we sought to determine the frequency and indications for broad-spectrum oral cephalosporins prescribed in ambulatory settings at a large, freestanding, children's hospital network. MethodsWe conducted a retrospective observational cohort study by EMR chart review of broad-spectrum oral cephalosporins prescribed in ambulatory settings within a freestanding children's hospital network from January 1 through December 31, 2019, where >750,000 ambulatory encounters occurred. Encounters from the emergency department, urgent care, general, and subspecialty clinics for patients aged ≤26 years with broad-spectrum oral cephalosporin prescriptions (ie, cefdinir, cefixime, cefpodoxime, cefprozil, cefuroxime) were included. Encounters from the hematology-oncology clinic were excluded. Data were stored using REDCap. 7 Raw data were generated at the Children's Hospital Colorado. Derived data supporting findings of the study are available from N.M.P. upon request.Variables collected included age, antibiotic prescribed, antibiotic indication, allergies, recent antibiotic use (within 30 days),