Peer-reviewed article
146. Predictors of Long Duration Antibiotic Therapy for Urinary Tract Infections and Community-Acquired Pneumonia in Pediatric Ambulatory Care Settings
Shah R, Sun S, Scardina T, Patel S ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined why children receive different lengths of antibiotic treatment for urinary tract infections and pneumonia in outpatient settings at a US children's hospital network. Researchers found that younger children, those treated in emergency rooms, and those with Medicaid insurance were more likely to receive longer courses of antibiotics. The study included over 3,100 prescriptions and found that race, ethnicity, and gender did not explain differences in treatment duration.
Key points
- 59.9% of children with community-acquired pneumonia and 47.6% with urinary tract infections received antibiotics for 10 days or longer
- Children discharged from the emergency room were significantly more likely to receive prolonged antibiotics compared to those seen in clinics
- Younger age was associated with longer antibiotic courses for both conditions
- Medicaid-insured children were more likely to receive extended antibiotic treatment than those with other insurance
- Race, ethnicity, gender, and primary language were not associated with prolonged antibiotic duration
Limitations
This is a retrospective observational study from a single hospital network, so findings may not generalise to other settings or healthcare systems. The study identifies associations but cannot determine whether longer antibiotic courses improve or harm child outcomes.
Abstract
Abstract Background Significant variation exists in the duration of antibiotic therapy for children in ambulatory care settings. Understanding drivers of variation for common conditions such as community-acquired pneumonia (CAP) and urinary tract infection (UTI) is important to informing antimicrobial stewardship interventions. Methods A retrospective observational study was conducted of patients with CAP and UTI seen in outpatient clinics or discharged from the emergency room (ER) of a tertiary care children’s hospital network from 2016 – 2019. Diagnoses CAP and UTI were identified via ICD-10 coding. Only oral medications ordered for ≥ 3 and < 28 days were included. Multivariable logistic regression was performed to identify predictors of long antibiotic duration (defined as ≥ 10 days). Potential non-clinical drivers of longer duration included race, ethnicity, sex, primary language, and insurance status. Results A total of 2,104 prescriptions for CAP from 442 prescribers and 1,070 prescriptions for UTI from 314 prescribers were included. Antibiotic durations were ≥ 10 days in 59.9% and 47.6% of prescriptions for CAP and UTI, respectively. Long duration of therapy was more common in children discharged from the ER when compared to clinics for both CAP (OR 1.795, 95% CI: 1.107 - 2.929), and UTI (OR 5.149, 95% CI: 1.933 - 16.373). The proportion of patients with long duration of therapy increased with younger age for both diagnoses and decreased overall in the final year of the study. Race, gender, ethnicity, and primary language were not associated with prolonged duration of therapy. However, patients with Medicaid insurance were more likely to receive long duration of therapy for CAP (OR 1.337, 95% CI: 1.062 - 1.682) and UTI (1.654, 95%, CI: 1.181 - 2.325). Conclusion In pediatric patients in ambulatory care settings, younger age, care in the ER, and being insured through Medicaid were independently associated with prolonged duration of therapy for both UTI and CAP. Disclosures All Authors: No reported disclosures