Nicole M. Poole
Nearly 7 million antibiotic prescriptions are made for children every year in both pediatric and nonpediatric EDs throughout the United States. According to research published in Pediatrics, children who presented to nonpediatric EDs were more likely to receive prescriptions for conditions for which antibiotics were not indicated and were more likely to receive broad-spectrum antibiotics.
“There is an urgent need to improve the quality of antibiotic prescribing for children in EDs nationwide,” Nicole M. Poole, MD, MPH, a pediatric infectious disease specialist at the University of Washington and Seattle Children’s Research Institute, told Infectious Diseases in Children. “Both general and pediatric EDs should prescribe antibiotics to children only when they are needed, and they should be prescribed according to pediatric-focused national guideline recommendations.”
The researchers conducted a cross-sectional retrospective study that included patients aged 0 to 17 years who presented to pediatric and nonpediatric EDs between 2009 and 2014. According to Poole and colleagues, an average of 29 million ED visits made by children occurred during the study period, with 14% of these patients presenting to pediatric EDs. Children were more likely to receive antibiotics when presenting to a nonpediatric ED (24%) than a pediatric ED (20%). The frequency of antibiotic prescribing for children was “stable” during the study period, the researchers said.
Findings showed that nearly half (44%) of antibiotics prescribed to children were broad-spectrum.
According to the researchers, 26% of antibiotic visits at pediatric EDs were for conditions for which antibiotics were generally not indicated. They said this finding “mirrors previous work on antibiotic prescribing for children with [acute respiratory tract infection] in the ambulatory and ED setting.” In nonpediatric EDs, the rate was even higher, with 33% of antibiotic visits made for conditions that did not require antibiotic treatment — accounting for more than 2 million unnecessary prescriptions each year in this setting. When the researchers examined the types of antibiotics used in EDs, nonpediatric EDs were more likely to prescribe macrolides (18% vs. 8%) and were less likely to prescribe the first-line antibiotics recommended in guidelines for respiratory conditions (77% vs. 87%).
“Clinical justification for unrecommended antibiotic use and personalized feedback to clinicians about their antibiotic prescribing practices has been shown to improve prescribing,” Poole said. “Communication training for clinicians has also been shown to decrease unnecessary prescribing if clinicians feel that the patient or parent expects an antibiotic that isn’t necessary.”– by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.