Antibiotic Prescriptions for Upper Respiratory Infections in a Pediatric Office Versus an Urgent Care Center

Abstract

It is estimated that as many as 10 million unnecessary antibiotic prescriptions are written each year for children. Children are more likely to receive antibiotics for an upper respiratory infection in an urgent care center compared with the primary care office. However, no study has examined the antibiotic prescribing practices of the same physicians in these settings. This retrospective chart review evaluated pediatricians’ antibiotic prescribing practices for patients with symptoms of an upper respiratory tract infection in the office setting and an urgent care setting. There was no difference in the total antibiotic prescribing rate by pediatricians in their primary care office versus an urgent care setting. Pediatricians who were high antibiotic prescribers in the office setting were also high prescribers in the urgent care. The highest prescribing physicians prescribed the appropriate recommended antibiotics for a particular diagnosis the lowest percentage of the time. Efforts to promote antimicrobial stewardship should be directed toward the individual physician and not toward the location where the patients are being evaluated.

Inter-prescriber variability in the decision to prescribe antibiotics to febrile patients attending primary care in Myanmar

“… 20 , 25 A study carried out in the USA demonstrated a high variability of antibiotic prescribing among paediatricians for respiratory tract infections in emergency care and primary care settings. 26 Substantial variation in high-risk non-steroidal anti-inflammatory drug prescribing among GPs in Scotland has also been noted. 27 Similarly, a cross-sectional study carried out in 457 GPs across six European countries showed that prescribing style remained an important source of variation in antibiotic prescription for patients with sore throat after adjusting for patient and GP characteristics.…”

Comparing the effects of antimicrobial stewardship at primary emergency centers

“…Moreover, inappropriate antibiotic prescription is associated with adverse consequences, such as increased cases of Clostridioides difficile infection 4,5 . In the United States, the majority of antibiotics are prescribed in the outpatient setting, 4 and studies have reported inappropriate antimicrobial use in such settings (e.g., retail clinics, urgent care clinics, and emergency departments) 6–10 . In these outpatient settings, various antimicrobial stewardship programs (ASPs), 11 such as provider feedback, 12 patient education, 13 communication skills training, 14 and clinical decision support, 15 have been implemented to prevent the rapid spread of AMR bacteria.…”

“…emergency departments). [6][7][8][9][10] In these outpatient settings, various antimicrobial stewardship programs (ASPs), 11 such as provider feedback, 12 patient education, 13 communication skills training, 14 and clinical decision support, 15 have been implemented to prevent the rapid spread of AMR bacteria.…”

Acute Bacterial Sinusitis

“…Millions of cases of upper respiratory tract infections (URTIs) occur in the US each year and are more common among children than adults. Most URTIs are viral in origin and self-limited, but up to 50% of all patient encounters for viral URTI may result in an antibiotic prescription . Approximately 7.5% of URTIs in children are complicated by acute bacterial sinusitis .…”

“…Clinical guidelines for diagnosis and treatment are an important foundation for antibiotic stewardship in ambulatory pediatrics. Antibiotic stewardship is an area of increasing importance, particularly in ambulatory pediatrics because viral URTIs are common . Management of URTIs includes parental reassurance, clear anticipatory guidance around viral illnesses, and specific supportive care suggestions .…”