Prescription of antibiotics in primary care varies for community-acquired pneumonia

The choice of antibiotics for community-acquired pneumonia (CAP) in children varied according to practices, and factors contributing to this variation include patient age, previous antibiotic receipt, and private insurance, according to a study published in Pediatrics.

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Lori K Handy, Division of Infectious Diseases, Nemours Hospital / Alfred I. duPont for Children in Wilmington, Delaware, and colleagues sought to determine patient and clinician characteristics associated with the prescription of amoxicillin vs. macrolide or other -spectrum antibiotics For the CAP. The researchers conducted a retrospective cohort study in an outpatient pediatric primary care network from July 1, 2009 to June 30, 2013. Patients given amoxicillin, macrolides or a broad spectrum antibiotic (amoxicillin-acid Clavulanic, cephalosporin or fluoroquinolone) for the CAP.

A total of 10,414 children were included: 4,239 (40.7%) received amoxicillin, 4,430 (42.5%) received macrolides and 1,745 (16.8%) received broad spectrum antibiotics. Factors associated with an increased likelihood of receiving macrolides compared to amoxicillin included patient age> 5 years (odds ratio [OR], 6.18), previous antibiotic receipt (OR, 1.79), and private insurance (OR , 1.47). The predicted probability of a child receiving a macrolide varied significantly between 0.22 and 0.83 in the clinics. Non-clinical characteristics associated with an increased likelihood of receiving broad-spectrum antibiotics compared to amoxicillin included suburban practice (OR, 7.50) and private insurance (OR, 1.42).

“Antibiotic choice for CAP varied widely across practices,” said the authors. “Factors unlikely related to the microbiologic etiology of CAP were significant drivers of antibiotic choice. Understanding drivers of off-guideline prescribing can inform targeted antimicrobial stewardship initiatives.”