Racial and Ethnic Differences in Antibiotic Use for Viral Illness in Emergency Departments

Goyal, Monika K.; Johnson, Tiffani J.; Chamberlain, James M.; Casper, T. Charles; Simmons, Timothy; Alessandrini, Evaline A.; Bajaj, Lalit; Grundmeier, Robert W.; Gerber, Jeffrey S.; Lorch, Scott A.; Alpern, Elizabeth R.

doi:10.1542/peds.2017-0203

Cited by 129 publications

(112 citation statements)

References 31 publications

(27 reference statements)

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“…T A G G E D P PREVIOUS RESEARCH INDICATES that there are racial and ethnic differences in rates of diagnostic testing and clinical interventions of pediatric patients treated in the pediatric emergency department (PED). 1,2 In 1 study, non-Hispanic white patients were more likely to receive analgesics for abdominal pain compared to non-Hispanic black or Hispanic patients. 2 In another study, non-Hispanic white patients were more likely to receive antibiotics for viral illnesses compared to non-Hispanic black or Hispanic patients, regardless of provider type, insurance status, or acuity.…”

Section: T a G G E D P What's Newmentioning

confidence: 99%

“…2 In another study, non-Hispanic white patients were more likely to receive antibiotics for viral illnesses compared to non-Hispanic black or Hispanic patients, regardless of provider type, insurance status, or acuity. 1 Although racial and ethnic disparities among pediatric patients are widely known, disparities in PED management among patients and families with language barriers and limited English proficiency have not been as thoroughly investigated.…”

Section: T a G G E D P What's Newmentioning

confidence: 99%

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Language Barriers and the Management of Bronchiolitis in a Pediatric Emergency Department

Zamor

Byczkowski

Yin

et al. 2020

Academic Pediatrics

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Section: T a G G E D P What's Newmentioning

confidence: 99%

Section: T a G G E D P What's Newmentioning

confidence: 99%

Language Barriers and the Management of Bronchiolitis in a Pediatric Emergency Department

Zamor

Byczkowski

Yin

et al. 2020

Academic Pediatrics

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“…Two retrospective cohort studies also reported white patients to receive more antibiotics compared to black and Hispanic; however, these analyses only included children. 22,23 To date, our study is the only available report that identified racial differences in antibiotic prescribing for sinusitis in adults. Further investigation in this area is warranted.…”

Section: Discussionmentioning

confidence: 95%

Using Clinical Decision Support Within the Electronic Health Record to Reduce Incorrect Prescribing for Acute Sinusitis

Ginzburg

Conway

Waltermaurer

et al. 2018

Journal of Patient-Centered Research and Reviews

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Journal of Patient-Centered Research and Reviews ( JPCRR) is a peerreviewed scientific journal whose mission is to communicate clinical and bench research findings, with the goal of improving the quality of human health, the care of the individual patient, and the care of populations. Recommended CitationGinzburg R, Conway JJ, Waltermaurer E, Song W, Jellinek-Cohen SP. Using clinical decision support within the electronic health record to reduce incorrect prescribing for acute sinusitis.

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“…These considerations suggest that vaccines against pathogens that cause respiratory infections, such as Bordetella pertussis, Streptococcus pneumoniae, influenza virus, and respiratory syncytial virus, may substantially reduce the exposure of a broad range of pathogenic bacterial species to antibiotics, via prevention of bystander selection. Notably, this includes vaccines that prevent viral respiratory infections, which are often inappropriately treated with antibiotics (14) and perhaps prevent bacterial secondary infections that might be appropriately treated if they occurred (15) . We have described an approach for using estimates of bystander exposures to estimate how vaccines could reduce exposure across various non-target pathogens.…”

Section: Discussionmentioning

confidence: 99%

Estimating the proportion of bystander selection for antibiotic resistance in the US

Tedijanto

Olesen

Grad

et al. 2018

Preprint

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Bystander selection --the selective pressures for resistance exerted by antibiotics on microbes that are not the target pathogen of treatment --is critical to understanding the total impact of broad-spectrum antibiotic use on pathogenic bacterial species that are often carried asymptomatically. However, to our knowledge, this effect has never been quantified. We quantify bystander selection for resistance for a range of clinically relevant antibiotic-species pairs as the proportion of all antibiotic exposures received by a species for conditions in which that species was not the causative pathogen ("proportion of bystander exposures"). Data sources include the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS), the Human Microbiome Project, and additional carriage and etiological data from existing literature. For outpatient prescribing in the United States, we find that this proportion over all included antibiotics is over 80% for 8 of 9 organisms of interest. Low proportions of bystander exposure are often associated with infrequent bacterial carriage or concentrated prescribing of a particular antibiotic for conditions caused by the species of interest. Applying our results, we roughly estimate that pneumococcal conjugate vaccination programs result in nearly the same proportional reduction in total antibiotic exposures to S. pneumoniae , S. aureus , and E. coli , despite the latter two organisms not being targeted by the vaccine. These results underscore the importance of considering antibiotic exposures to bystanders, in addition to the target pathogen, in measuring the impact of antibiotic resistance interventions. Significance StatementBystander selection, defined as the inadvertent pressures imposed by antibiotic treatment on microbes other than the targeted pathogen, is hypothesized to be a major factor in the propagation of antibiotic resistance, but its extent has not been characterized. We estimate the proportion of bystander exposures across a range of antibiotics and organisms and describe factors driving variability of these proportions. Impact estimates for antibiotic resistance interventions, including vaccination, are often limited to effects on a target pathogen. However, the reduction of antibiotic treatment for conditions caused by one pathogen may have the broader potential to decrease bystander selection pressures for resistance on many other organisms.

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Racial and Ethnic Differences in Antibiotic Use for Viral Illness in Emergency Departments

Cited by 129 publications

References 31 publications

Language Barriers and the Management of Bronchiolitis in a Pediatric Emergency Department

Language Barriers and the Management of Bronchiolitis in a Pediatric Emergency Department

Using Clinical Decision Support Within the Electronic Health Record to Reduce Incorrect Prescribing for Acute Sinusitis

Estimating the proportion of bystander selection for antibiotic resistance in the US

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