Seattle, WA—Pharmacists may have noticed that emergency departments (EDs) prescribe too many antibiotics to children, but what they may not realize is that the problem is worse at EDs that don’t specialize in pediatric patients.

A study in the journal Pediatrics sought to characterize and compare ambulatory antibiotic prescribing for children in U.S. pediatric versus nonpediatric EDs.

To do that, University of Washington–led researchers conducted a cross-sectional retrospective study of patients aged 0 to 17 years discharged from EDs in the United States. Used for the study was 2009–2014 National Hospital Ambulatory Medical Care Survey ED data.

The research team estimated the proportion of ED visits resulting in antibiotic prescriptions, stratified by antibiotic spectrum, class, diagnosis, and ED type. The focus was on first-line, guideline-concordant prescribing for acute otitis media, pharyngitis, and sinusitis.

Researchers report that, in the 2009–2014 time period, children had 29 million mean annual ED visits, with 14% of them occurring at pediatric-only facilities.

Results indicate that, overall, antibiotics were prescribed more frequently in nonpediatric than pediatric ED visits—24% versus 20% (P <.01), although antibiotic prescribing frequencies were stable over time.

Also concerning to the study team was that, of all antibiotics prescribed, 44% (95% CI: 42%-45%) were broad spectrum, and 32% (95% CI, 30%-34%, 2.1 million per year) were generally not indicated.

Researchers point out that, compared with pediatric EDs, nonpediatric EDs had a higher frequency of prescribing macrolides (18% vs. 8%, P <.0001) and a lower frequency of first-line, guideline-concordant prescribing for the respiratory conditions studied (77% vs. 87%, P <.001).

“Children are prescribed almost 7 million antibiotic prescriptions in EDs annually, primarily in non-pediatric EDs,” study authors conclude. “Pediatric antibiotic stewardship efforts should expand to non-pediatric EDs nationwide, particularly regarding avoidance of antibiotic prescribing for conditions for which antibiotics are not indicated, reducing macrolide prescriptions, and increasing first-line, guideline-concordant prescribing.”

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