Clinical Edge

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Pediatric Antibiotic Prescribing in US EDs Examined

Pediatrics; ePub 2019 Jan 8; Poole, Shapiro, et al

Children are prescribed almost 7 million antibiotic prescriptions in US emergency departments (EDs) annually, primarily in non-pediatric EDs, according to a recent study. Therefore, pediatric antibiotic stewardship efforts should expand to non-pediatric EDs nationwide, particularly regarding avoidance of antibiotic prescribing for conditions for which antibiotics are not indicated. A cross-sectional retrospective study of patients aged 0 to 17 years discharged from EDs in the US was conducted by using the 2009–2014 National Hospital Ambulatory Medical Care Survey ED data. They found:

  • In 2009–2014, of the 29 million mean annual ED visits by children, 14% occurred at pediatric EDs.
  • Antibiotics overall were prescribed more frequently in non-pediatric than pediatric ED visits (24% vs 20%).
  • Antibiotic prescribing frequencies were stable over time.
  • Of all antibiotics prescribed, 44% were broad spectrum, and 32% were generally not indicated.
  • Compared with pediatric EDs, non-pediatric EDs had a higher frequency of prescribing macrolides (18% vs 8%) and a lower frequency of first-line, guideline-concordant prescribing for the respiratory conditions studied (77% vs 87%).

Poole NM, Shapiro DJ, Fleming-Dutra KE, Hicks LA, Hersh AK, Kronman MP. Antibiotic prescribing for children in United States emergency departments: 2009–2014. [Published online ahead of print January 8, 2019]. Pediatrics. doi:10.1542/peds.2018-1056.