Inappropriate Antibiotic Prescribing in Ambulatory Pediatrics

Antibiotics are among the most frequently prescribed medication in pediatrics, with more than 30 million prescriptions written for children annually. Although overall rates of antibiotic prescribing in ambulatory settings have declined, antibiotic overuse continues and contributes to development of antibiotic-resistant pathogens, unnecessary costs, and avoidable adverse events. To examine antibiotic prescribing patterns in U.S. ambulatory pediatrics, researchers analyzed two nationwide datasets representing visits to offices, outpatient departments, and emergency departments by children younger than 18 years from 2006 to 2008. Antibiotics were categorized as narrow (e.g., amoxicillin) and broad spectrum (e.g., azithromycin), based on national standards.

Antibiotics were prescribed in an estimated 49 million pediatric ambulatory visits (21% of visits). Broad-spectrum antibiotics were prescribed in 50% of these visits, with macrolides (primarily azithromycin) prescribed most often, followed by broad-spectrum cephalosporins. Respiratory conditions accounted for most (72%) visits in which antibiotics were prescribed. Of concern, prescriptions for broad-spectrum antibiotics were highest (63%) for acute respiratory tract infections for which antibiotics were not indicated (such as for nasopharyngitis, bronchitis, viral pneumonia, and influenza). For example, an estimated 2.1 million prescriptions were written for bronchitis annually. Children with public or no insurance were significantly less likely than those with private insurance to receive broad-spectrum antibiotics.