Antibiotic prescribing in primary care varies for community-acquired pneumonia

Factors that contribute to antibiotic choice for CAP include patient age, previous antibiotic receipt, and private insurance.
Factors that contribute to antibiotic choice for CAP include patient age, previous antibiotic receipt, and private insurance.

Antibiotic choice for community-acquired pneumonia (CAP) in children varied across practices, and factors contributing to this variation include patient age, previous antibiotic receipt, and private insurance, according to a study published in Pediatrics.

Lori K Handy, MD, from the Division of Infectious Diseases, at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, and colleagues sought to determine the patient and clinician characteristics associated with the prescription of amoxicillin vs macrolide or other broad-spectrum antibiotics for CAP. The researchers conducted a retrospective cohort study in an outpatient pediatric primary care network from July 1, 2009 to June 30, 2013. Patients who were prescribed amoxicillin, macrolides, or a broad-spectrum antibiotic (amoxicillin-clavulanic acid, cephalosporin, or fluoroquinolone) for CAP were included.

A total of 10,414 children were included: 4,239 (40.7%) received amoxicillin, 4,430 (42.5%) received macrolides, and 1,745 (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 (odds ratio [OR], 6.18), previous antibiotic receipt (OR, 1.79), and private insurance (OR, 1.47). 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 (OR, 7.50) and private insurance (OR, 1.42).

“Antibiotic choice for CAP varied widely across practices,” said the authors. “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.”

Reference

  1. Handy LK, Bryan M, Gerber JS, et al. Variability in Antibiotic Prescribing for Community-Acquired Pneumonia. Pediatrics. 2017 Mar 7. doi: 10.1542/peds.2016-2331
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