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2017 ; 139
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): ä Nephropedia Template TP
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Variability in Antibiotic Prescribing for Community-Acquired Pneumonia
#MMPMID28270546
Handy LK
; Bryan M
; Gerber JS
; Zaoutis T
; Feemster KA
Pediatrics
2017[Apr]; 139
(4
): ä PMID28270546
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BACKGROUND AND OBJECTIVES: Published guidelines recommend amoxicillin for most
children with community-acquired pneumonia (CAP), yet macrolides and
broad-spectrum antibiotics are more commonly prescribed. We aimed to determine
the patient and clinician characteristics associated with the prescription of
amoxicillin versus macrolide or broad-spectrum antibiotics for CAP. METHODS:
Retrospective cohort study in an outpatient pediatric primary care network from
July 1, 2009 to June 30, 2013. Patients prescribed amoxicillin, macrolides, or a
broad-spectrum antibiotic (amoxicillin-clavulanic acid, cephalosporin, or
fluoroquinolone) for CAP were included. Multivariable logistic regression models
were implemented to identify predictors of antibiotic choice for CAP based on
patient- and clinician-level characteristics, controlling for practice. RESULTS:
Of 10?414 children, 4239 (40.7%) received amoxicillin, 4430 (42.5%) received
macrolides and 1745 (16.8%) received broad-spectrum antibiotics. The factors
associated with an increased odds of receipt of macrolides compared with
amoxicillin included patient age ?5 years (adjusted odds ratio [aOR]: 6.18; 95%
confidence interval [CI]: 5.53-6.91), previous antibiotic receipt (aOR: 1.79; 95%
CI: 1.56-2.04), and private insurance (aOR: 1.47; 95% CI: 1.28-1.70). The
predicted probability of a child being prescribed a macrolide ranged
significantly between 0.22 and 0.83 across clinics. The nonclinical
characteristics associated with an increased odds of receipt of broad-spectrum
antibiotics compared with amoxicillin included suburban practice (aOR: 7.50; 95%
CI: 4.16-13.55) and private insurance (aOR: 1.42; 95% CI: 1.18-1.71).
CONCLUSIONS: Antibiotic choice for CAP varied widely across practices. Factors
unlikely related to the microbiologic etiology of CAP were significant drivers of
antibiotic choice. Understanding drivers of off-guideline prescribing can inform
targeted antimicrobial stewardship initiatives.
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