Drivers of Prolonged Outpatient Antibiotic Therapy for Urinary Tract Infections and Community-Acquired Pneumonia. Issue 12 (14th August 2022)

• Record Type: Journal Article
• Authors: Shah, Rohan M; Sun, Shan; Shteynberg, Emily; Scardina, Tonya; Whitmer, Grant; Patel, Sameer J
• Is Part Of: Journal of the Pediatric Infectious Diseases Society. Volume 11:Issue 12(2022)
• Page Start: 543
• Page End: 549
• Publication Date: 2022-08-14
• Subjects: antibiotic stewardship -- antibiotic resistance -- duration; Communicable diseases in children -- Periodicals; Children -- Diseases -- Periodicals; 618.929
• DOI: 10.1093/jpids/piac083
• Languages: English
• ISSNs: 2048-7193

Abstract

Abstract: Background: Variability exists in treatment duration for community-acquired pneumonia (CAP) and urinary tract infection (UTI) in children and may be associated with non-clinical factors. Methods: A retrospective study was conducted of patients treated for outpatient CAP and UTI in a children's hospital network from 2016 to 2019. Multivariable logistic regression was performed to identify predictors of long antibiotic duration (≥10 days). Hospitalization within 30 days was determined. Results: Overall, 2124 prescriptions for CAP and 1116 prescriptions for UTI were included. Prescriptions were ≥10 days in 59.9% and 47.6% for CAP and UTI, respectively. Long durations were more common in the emergency department (ED) than in clinics for UTI's ( P = .0082), and more common in convenient care for CAP ( P = .045). In UTI's, Asian and Hispanic patients received shorter durations than white patients. Younger children had greater odds of long duration for both diagnoses. Medicaid insurance was associated with long therapy for UTI (OR: 1.660, P = .0042) and CAP (OR: 1.426, P = .0169). Residents and fellows were less likely to give long durations than attending physicians ( P < .0001). APNs were more likely to administer long therapies in CAP ( P = .0062). Subsequent hospitalizations were uncommon for UTI ( n = 10) and CAP ( n = 20). Conclusions: Younger age, Medicaid insurance, ED, and convenient care visits were associated with a long duration of therapy. Residents and fellows were less likely to give long durations. Abstract : Our article retrospectively evaluates drivers of long antibiotic prescriptions for urinary tract infections and community-acquired pneumonia in ambulatory care settings. We found that younger age, Medicaid insurance, the emergency department, and convenient care settings were associated with longer therapies. Medical residents and fellows were less likely to administer long durations.