PURPOSE OF THE STUDY.
To determine how frequently antibiotics are prescribed during pediatric asthma visits without documented coexisting diagnoses that justify their use.
Pediatric patients <18 years of age seen in outpatient offices and emergency departments in the United States for asthma between 1998 and 2007.
Data from the National Ambulatory Medical Care Surveys and the National Hospital Ambulatory Medical Care Survey were examined for patients seen for asthma in clinics and emergency departments. Each visit was assessed with regard to reason for visit and diagnoses (by using International Classification of Diseases, Ninth Revision, Clinical Modification codes), medications prescribed, physician specialty, participation of allied health professionals, patient demographics, and performance of asthma education (after 2001). Multivariable logistic regression models then were used to assess associations with the prescription of antibiotics.
Antibiotics were prescribed during 15.6% of 5198 ambulatory care visits for asthma without a coexisting diagnosis to justify treatment. This finding equates to ∼1 million pediatric ambulatory patient visits per year in the United States, in which patients with asthma are treated with antibiotics without documentation of a reason for doing so. Macrolides were prescribed nearly 50% of the time, followed by aminopenicillins (26.3%) and cephalosporins (20.6%). Multivariate analysis revealed that antibiotics were prescribed more in the winter (odds ratio [OR]: 1.92; 95% confidence interval [CI]: 1.05–3.52), and when systemic steroids were also prescribed, the OR = 2.69 (95% CI: 1.68–4.3). Treatment in an emergency department was associated with decreased likelihood of antibiotic prescribing (OR: 0.48; 95% CI: 0.26–0.89), whereas in the office-based setting, asthma education during the visit was associated with reduced antibiotic prescribing (OR: 0.46; 95% CI: 0.24–0.86).
Approximately 1 of every 6 pediatric patients evaluated for asthma in an ambulatory care setting is prescribed antibiotics without a documented indication, which indicates a need for either better documentation or more education and interventions to prevent the unindicated use of antibiotics for asthma exacerbations.
Although guidelines for asthma management do not support routine antibiotic therapy for asthma exacerbations, this study showed that it is a fairly common practice in ambulatory care settings. Educational programs to increase awareness of inappropriate antibiotic prescriptions should be developed. Previous publications have shown that multifaceted interventions, such as physician education, patient education, community-wide programs, and provider feedback are more likely to be successful than single interventions alone.
- Copyright © 2012 by the American Academy of Pediatrics