A team of US researchers reported benchmarking data for outpatient prescribing in pediatric settings yesterday in the Journal of the Pediatric Infectious Diseases Society.
For the study, institutions from the Sharing Antimicrobial Reports for Pediatric Stewardship OutPatient (SHARPS-OP) Collaborative were invited to contribute quarterly aggregate reports on outpatient oral antibiotic prescriptions in patients under 20 years of age from January 2019 through June 2022. Outpatient settings included emergency departments (EDs), urgent care centers (UCCs), primary care clinics (PCCs), and telehealth encounters. Each institution then received a benchmark report comparing their institution with the others that provided data.
Benchmarking metrics included the percentages of all acute encounters resulting in an antibiotic prescription, acute respiratory infection (ARI) encounters resulting in an antibiotic prescription, encounters resulting in an amoxicillin prescription (the "amoxicillin index"), and encounters resulting in an azithromycin prescription (the "azithromycin index"). The researchers also collected rates of antibiotic courses that were 7 days or shorter and 10 days or shorter.
Overall, antibiotics were prescribed in less than one fifth of all acute encounters. Antibiotic prescribing for ARI varied between settings, with the highest rates observed in UCCs (40.2%) and the lowest in telehealth (19.1%), though there was substantial variation in prescribing for ARI encounters via telehealth. The amoxicillin index was highest for EDs (76.2%) and lowest for telehealth (55.8%), while the azithromycin index was similar for EDs, UCCs, and PCCs (3.8%, 3.7%, and 5.0% respectively). Antibiotic duration of 7 days or less also varied substantially (46.4% for EDs, 27.8% for UCCs, 23.7% for telehealth, and 16.4% for PCCs).
We will continue to collect and report quarterly antibiotic use to trend over time, with the goal of identifying high-performers and potential 'appropriate' levels for our metrics.
The study authors say they hope to use the benchmarking data to develop national standards for pediatric ARI prescribing.
"We will continue to collect and report quarterly antibiotic use to trend over time, with the goal of identifying high-performers and potential 'appropriate' levels for our metrics, and empowering institutions with data to develop approaches to reduce inappropriate antibiotic use in the patients cared for at their institutions," they wrote.