Antibiotic Utilization and Efficacy Associated With Treating Pediatric Urinary Tract Infections in Texas Medicaid Patients in the First Year of Life. Issue 11 (November 2021)

• Record Type: Journal Article
• Authors: Coleman, Alana; Vohra, Yogesh; Rascati, Karen; Kubes, Sarah; Moffett, Brady
• Is Part Of: Pediatric infectious disease journal. Volume 40:Issue 11(2021)
• Publication Date: 2021-11
• Subjects: pediatrics -- urinary tract infection -- antibiotic -- utilization -- treatment failure -- outpatient; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000003272
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: Historically, amoxicillin (Amoxil) has been used as a first-line agent to treat pediatric urinary tract infections (UTIs). However, emerging resistance of urinary pathogens has led to broader treatment options, such as cefdinir (Omnicef). This shift in prescribing practices is predicted to vary among place of service and gender due to differing institutional protocols and antimicrobial stewardship practices. Objective: Describe the utilization patterns for treating pediatric UTIs across outpatient places of service and gender and to assess treatment efficacy of the antibiotics that were prescribed. Methods: Texas Medicaid prescription and medical claims data for patients under 1 year of age were included in the analysis if they presented with a UTI to a healthcare practitioner's office or the emergency department (ED) and were treated with an outpatient antibiotic. Treatment efficacy was assessed by whether a patient received a second (different) antibiotic within 7 days of their initial antibiotic fill. Results: A total of 12, 795 visits met inclusion criteria; 12, 561 visits included prescriptions for the top 4 antibiotics: cefdinir (50%), amoxicillin (25%), cephalexin (Keflex; 13%), and amoxicillin-clavulanate (Augmentin; 12%). Cefdinir utilization predominated in both places of service [office (50%) and ED (55%)], and gender [males (47%) and females (52%)]. Controlling for gender and place of service, initial treatment with amoxicillin when compared with cefdinir (OR = 2.54; 95% confidence intervals: 1.84–3.54; P < 0.001) was associated with a greater rate of treatment failure. Conclusions: In this study of Texas Medicaid patients, the widespread utilization of cefdinir may be appropriate for the empiric treatment of uncomplicated UTIs as it has a lower incidence of treatment failure compare failure compared with amoxicillin.