Antibiotic prescribing during pediatric ambulatory care visits for asthma

Ian M. Paul, Judith H. Maselli, Adam L. Hersh, Homer A. Boushey, Dennis W. Nielson, Michael D. Cabana

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

OBJECTIVE: National guidelines do not recommend antibiotics as an asthma therapy. We sought to examine the frequency of inappropriate antibiotic prescribing during US ambulatory care pediatric asthma visits as well as the patient, provider, and systemic variables associated with such practice. PATIENTS AND METHODS: Data from the National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Survey were examined to assess office and emergency-department asthma visits made by children (aged <18 years) for frequencies of antibiotic prescription. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to assess the presence of coexisting conditions warranting antibiotics. Multivariable logistic regression models assessed associations with the prescription of antibiotics. RESULTS: From 1998 to 2007, an estimated 60.4 million visits occurred for asthma without another ICD-9 code justifying antibiotic prescription. Antibiotics were prescribed during 16% of these visits, most commonly macrolides (48.8%). In multivariate analysis, controlling for patient age, gender, race, insurance type, region, and controller medication use, systemic corticosteroid prescription (odds ratio [OR]: 2.69 [95% confidence interval (CI): 1.68-4.30]) and treatment during the winter (OR: 1.92 [95% CI: 1.05-3.52]) were associated with an increased likelihood of antibiotic prescription, whereas treatment in an emergency department was associated with decreased likelihood (OR: 0.48 [95% CI: 0.26-0.89]). A second multivariate analysis of only officebased visits demonstrated that asthma education during the visits was associated with reduced antibiotic prescriptions (OR: 0.46 [95% CI: 0.24-0.86]). CONCLUSIONS: Antibiotics are prescribed during nearly 1 in 6 US pediatric ambulatory care visits for asthma, ∼1 million prescriptions annually, when antibiotic need is undocumented. Additional education and interventions are needed to prevent unnecessary antibiotic prescribing for asthma.

Original languageEnglish (US)
Pages (from-to)1014-1021
Number of pages8
JournalPediatrics
Volume127
Issue number6
DOIs
StatePublished - Jun 1 2011
Externally publishedYes

Fingerprint

Ambulatory Care
Asthma
Pediatrics
Anti-Bacterial Agents
Prescriptions
International Classification of Diseases
Odds Ratio
Confidence Intervals
Health Care Surveys
Hospital Emergency Service
Multivariate Analysis
Logistic Models
Inappropriate Prescribing
Education
Macrolides
Insurance
Adrenal Cortex Hormones
Therapeutics
Guidelines

Keywords

  • Ambulatory care
  • Antibiotics
  • Asthma
  • Emergency department

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Paul, I. M., Maselli, J. H., Hersh, A. L., Boushey, H. A., Nielson, D. W., & Cabana, M. D. (2011). Antibiotic prescribing during pediatric ambulatory care visits for asthma. Pediatrics, 127(6), 1014-1021. https://doi.org/10.1542/peds.2011-0218

Antibiotic prescribing during pediatric ambulatory care visits for asthma. / Paul, Ian M.; Maselli, Judith H.; Hersh, Adam L.; Boushey, Homer A.; Nielson, Dennis W.; Cabana, Michael D.

In: Pediatrics, Vol. 127, No. 6, 01.06.2011, p. 1014-1021.

Research output: Contribution to journalArticle

Paul, IM, Maselli, JH, Hersh, AL, Boushey, HA, Nielson, DW & Cabana, MD 2011, 'Antibiotic prescribing during pediatric ambulatory care visits for asthma', Pediatrics, vol. 127, no. 6, pp. 1014-1021. https://doi.org/10.1542/peds.2011-0218
Paul IM, Maselli JH, Hersh AL, Boushey HA, Nielson DW, Cabana MD. Antibiotic prescribing during pediatric ambulatory care visits for asthma. Pediatrics. 2011 Jun 1;127(6):1014-1021. https://doi.org/10.1542/peds.2011-0218
Paul, Ian M. ; Maselli, Judith H. ; Hersh, Adam L. ; Boushey, Homer A. ; Nielson, Dennis W. ; Cabana, Michael D. / Antibiotic prescribing during pediatric ambulatory care visits for asthma. In: Pediatrics. 2011 ; Vol. 127, No. 6. pp. 1014-1021.
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abstract = "OBJECTIVE: National guidelines do not recommend antibiotics as an asthma therapy. We sought to examine the frequency of inappropriate antibiotic prescribing during US ambulatory care pediatric asthma visits as well as the patient, provider, and systemic variables associated with such practice. PATIENTS AND METHODS: Data from the National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Survey were examined to assess office and emergency-department asthma visits made by children (aged <18 years) for frequencies of antibiotic prescription. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to assess the presence of coexisting conditions warranting antibiotics. Multivariable logistic regression models assessed associations with the prescription of antibiotics. RESULTS: From 1998 to 2007, an estimated 60.4 million visits occurred for asthma without another ICD-9 code justifying antibiotic prescription. Antibiotics were prescribed during 16{\%} of these visits, most commonly macrolides (48.8{\%}). In multivariate analysis, controlling for patient age, gender, race, insurance type, region, and controller medication use, systemic corticosteroid prescription (odds ratio [OR]: 2.69 [95{\%} confidence interval (CI): 1.68-4.30]) and treatment during the winter (OR: 1.92 [95{\%} CI: 1.05-3.52]) were associated with an increased likelihood of antibiotic prescription, whereas treatment in an emergency department was associated with decreased likelihood (OR: 0.48 [95{\%} CI: 0.26-0.89]). A second multivariate analysis of only officebased visits demonstrated that asthma education during the visits was associated with reduced antibiotic prescriptions (OR: 0.46 [95{\%} CI: 0.24-0.86]). CONCLUSIONS: Antibiotics are prescribed during nearly 1 in 6 US pediatric ambulatory care visits for asthma, ∼1 million prescriptions annually, when antibiotic need is undocumented. Additional education and interventions are needed to prevent unnecessary antibiotic prescribing for asthma.",
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N2 - OBJECTIVE: National guidelines do not recommend antibiotics as an asthma therapy. We sought to examine the frequency of inappropriate antibiotic prescribing during US ambulatory care pediatric asthma visits as well as the patient, provider, and systemic variables associated with such practice. PATIENTS AND METHODS: Data from the National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Survey were examined to assess office and emergency-department asthma visits made by children (aged <18 years) for frequencies of antibiotic prescription. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to assess the presence of coexisting conditions warranting antibiotics. Multivariable logistic regression models assessed associations with the prescription of antibiotics. RESULTS: From 1998 to 2007, an estimated 60.4 million visits occurred for asthma without another ICD-9 code justifying antibiotic prescription. Antibiotics were prescribed during 16% of these visits, most commonly macrolides (48.8%). In multivariate analysis, controlling for patient age, gender, race, insurance type, region, and controller medication use, systemic corticosteroid prescription (odds ratio [OR]: 2.69 [95% confidence interval (CI): 1.68-4.30]) and treatment during the winter (OR: 1.92 [95% CI: 1.05-3.52]) were associated with an increased likelihood of antibiotic prescription, whereas treatment in an emergency department was associated with decreased likelihood (OR: 0.48 [95% CI: 0.26-0.89]). A second multivariate analysis of only officebased visits demonstrated that asthma education during the visits was associated with reduced antibiotic prescriptions (OR: 0.46 [95% CI: 0.24-0.86]). CONCLUSIONS: Antibiotics are prescribed during nearly 1 in 6 US pediatric ambulatory care visits for asthma, ∼1 million prescriptions annually, when antibiotic need is undocumented. Additional education and interventions are needed to prevent unnecessary antibiotic prescribing for asthma.

AB - OBJECTIVE: National guidelines do not recommend antibiotics as an asthma therapy. We sought to examine the frequency of inappropriate antibiotic prescribing during US ambulatory care pediatric asthma visits as well as the patient, provider, and systemic variables associated with such practice. PATIENTS AND METHODS: Data from the National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Survey were examined to assess office and emergency-department asthma visits made by children (aged <18 years) for frequencies of antibiotic prescription. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to assess the presence of coexisting conditions warranting antibiotics. Multivariable logistic regression models assessed associations with the prescription of antibiotics. RESULTS: From 1998 to 2007, an estimated 60.4 million visits occurred for asthma without another ICD-9 code justifying antibiotic prescription. Antibiotics were prescribed during 16% of these visits, most commonly macrolides (48.8%). In multivariate analysis, controlling for patient age, gender, race, insurance type, region, and controller medication use, systemic corticosteroid prescription (odds ratio [OR]: 2.69 [95% confidence interval (CI): 1.68-4.30]) and treatment during the winter (OR: 1.92 [95% CI: 1.05-3.52]) were associated with an increased likelihood of antibiotic prescription, whereas treatment in an emergency department was associated with decreased likelihood (OR: 0.48 [95% CI: 0.26-0.89]). A second multivariate analysis of only officebased visits demonstrated that asthma education during the visits was associated with reduced antibiotic prescriptions (OR: 0.46 [95% CI: 0.24-0.86]). CONCLUSIONS: Antibiotics are prescribed during nearly 1 in 6 US pediatric ambulatory care visits for asthma, ∼1 million prescriptions annually, when antibiotic need is undocumented. Additional education and interventions are needed to prevent unnecessary antibiotic prescribing for asthma.

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