Antibiotic Prescribing in Ambulatory Pediatrics in the United States

Hersh, Adam L.; Shapiro, Daniel J.; Pavia, Andrew T.; Shah, Samir S.

doi:10.1542/peds.2011-1337

Cited by 415 publications

(419 citation statements)

References 33 publications

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“…Respiratory conditions were defined according to a previously published classification system using ICD-9-CM codes for common respiratory diagnoses, including 460-520 ("respiratory" category), mastoiditis (383), allergy (995.3), otitis media (381-382), and streptococcal sore throat (034). 13,14 National estimates for children #14 years of age with a diagnosis of respiratory conditions were produced from 15 694 visits that occurred from 2008 to 2010.…”

Section: Study Populationmentioning

confidence: 99%

“…16 Broad-spectrum antibiotics included macrolides (eg, azithromycin), quinolones, broad-spectrum penicillins (eg, b-lactam/b-lactamase inhibitor combinations), lincomycin derivatives (clindamycin), and broad-spectrum (second-or third-generation) cephalosporins. 13,14 Classification of antibiotics was based on the Multum Lexicon therapeutic classification system. 10 As a sensitivity analysis, we repeated the antibiotic prescribing and selection analyses using only the most common diagnostic code for OM (382.9, unspecified otitis media).…”

Section: Antibiotic Prescribingmentioning

confidence: 99%

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Race, Otitis Media, and Antibiotic Selection

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:A previous study suggested that physicians in 1 practice network were less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for OM for black versus nonblack children.WHAT THIS STUDY ADDS: Nationally, black children with OM are more likely to receive guideline-recommended, narrow-spectrum antibiotics than nonblack children. These findings may reflect inappropriate treatment of OM with the use of broad-spectrum antibiotics in a majority of US children. abstract BACKGROUND AND OBJECTIVE: Previous research suggests that physicians may be less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for black versus nonblack children. Our objective was to determine whether race is associated with differences in OM diagnosis and antibiotic prescribing nationally. METHODS:We examined OM visit rates during 2008 to 2010 for children #14 years old using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We compared OM visits between black and nonblack children, as percentages of all outpatient visits and visit rates per 1000. We compared antibiotic prescribing by race as the percentage of OM visits receiving narrowspectrum (eg, amoxicillin) versus broader-spectrum antibiotics. We used multivariable logistic regression to examine whether race was independently associated with antibiotic selection for OM. RESULTS:The percentage of all visits resulting in OM diagnosis was 30% lower in black children compared with others (7% vs 10%, P = .004). However, OM visits per 1000 population were not different between black and nonblack children (253 vs 321, P = .12). When diagnosed with OM during visits in which antibiotics were prescribed, black children were less likely to receive broad-spectrum antibiotics than nonblack children (42% vs 52%, P = .01). In multivariable analysis, black race was negatively associated with broad-spectrum antibiotic prescribing (adjusted odds ratio 0.59; 95% confidence interval, 0.40-0.86).CONCLUSIONS: Differences in treatment choice for black children with OM may indicate race-based differences in physician practice patterns and parental preferences for children with OM.

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Section: Study Populationmentioning

confidence: 99%

Section: Antibiotic Prescribingmentioning

confidence: 99%

Race, Otitis Media, and Antibiotic Selection

et al. 2014

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“…1 It is widely documented that inappropriate antibiotic prescribing, especially for upper respiratory tract infections (URIs) of viral origin, is common in ambulatory care. [1][2][3] As many as 10 million antibiotic prescriptions per year are directed toward respiratory conditions for which they are unlikely to provide benefit. 1 Recent evidence shows that broad-spectrum antibiotic prescribing has increased and frequently occurs when either no therapy is necessary or when narrower-spectrum alternatives are appropriate.…”

Section: Introductionmentioning

confidence: 99%

Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics

Hersh¹,

Jackson²,

Hicks³

et al. 2013

Pediatrics

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Most upper respiratory tract infections are caused by viruses and require no antibiotics. This clinical report focuses on antibiotic prescribing strategies for bacterial upper respiratory tract infections, including acute otitis media, acute bacterial sinusitis, and streptococcal pharyngitis. The principles for judicious antibiotic prescribing that are outlined focus on applying stringent diagnostic criteria, weighing the benefits and harms of antibiotic therapy, and understanding situations when antibiotics may not be indicated. The principles can be used to amplify messages from recent clinical guidelines for local guideline development and for patient communication; they are broadly applicable to antibiotic prescribing in general.

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“…Although higher than the expected prevalence of GAS pharyngitis (the only indication for antibiotics among those with acute pharyngitis), 21 " 24 the observed prescribing rate was lower than reported in prior studies, suggesting that antibiotic prescribing for acute pharyngitis might be improving. 1415 ' 25 However, nearly half of patients who were not tested for GAS and 13% of patients with negative GAS tests were prescribed antibiotics. These practices are at odds with AAP, CDC, and IDSA guidelines that recommend confirmatory GAS testing to dictate antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians

Fierro

Prasad

Localio

et al. 2014

Infect. Control Hosp. Epidemiol.

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OBJECTIVE. To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices.DESIGN. Retrospective cohort study.SETTING. All encounters to 25 pediatric primary care practices sharing an electronic health record.METHODS. Streptococcal pharyngitis was defined by an International Classification of Diseases, Ninth Revision code for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation.RESULTS. Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (P< .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (P< .05). Only 18 of the 222 clinicians in the network accounted for half of all off-guideline antibiotic prescribing.CONCLUSIONS. Significant variability in the diagnosis and treatment of pharyngitis exists across and within pediatric practices, which cannot be explained by relevant clinical or demographic factors. Our data support clinician-targeted interventions to improve adherence to prescribing guidelines for this common condition. Infect Control Hosp Epidemiol 2014;35(S3):S79-S85

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Antibiotic Prescribing in Ambulatory Pediatrics in the United States

Cited by 415 publications

References 33 publications

Race, Otitis Media, and Antibiotic Selection

Race, Otitis Media, and Antibiotic Selection

Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics

Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians

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