Stewardship / Resistance Scan for Aug 04, 2022

Telehealth antibiotic prescribing
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Guideline-concordant UTI prescribing

After early COVID peak, telehealth antibiotic prescribing for kids quickly fell

A study of data from a large pediatric primary care network found a quick decline in telehealth antibiotic prescribing following a peak during the first 3 months of the COVID-19 pandemic, researchers reported today in Pediatrics.

The study, led by researchers with Boston Children's Hospital, analyzed data telehealth and in-person encounters involving oral antibiotics in a network of 77 independent pediatric primary care practices across Massachusetts from March 2020 to July 2021. Focusing on the top five general diagnosis groupings, the researchers compared patient characteristics between populations that had at least one in-person encounter versus one telehealth video visit with an antibiotic prescribed.

Of the 55,926 encounters with an oral antibiotic prescribed, 12.5% were conducted via telehealth and 87.5% were in person. Patients in the telehealth group were older (median age 11) than patients in the in-person group (median age 9), and were more likely to be commercially insured, White non-Hispanic, and have complex chronic disease. The diagnosis for which an antibiotic was most frequently prescribed during telehealth visits was ear infection (30.8%), followed by skin and subcutaneous infection (21.8%), respiratory infection (18.8%), genitourinary infection (6.3%), and Lyme disease (3.8%).

The proportion of overall telehealth encounters with an antibiotic prescription peaked at 52.1% the week of Apr 27, 2020, then declined to an average of 2.4% over the last 4 weeks of the study period, and trends for individual diagnosis groups were similar, with peaks from March to May 2020 followed by a steady decline. The diagnoses with the greatest proportion of telehealth antibiotic prescribing during the last 4 weeks of the analysis were Lyme disease infections (11.7%) and skin and subcutaneous infections (3.1%).

The study authors say the findings "suggest that pediatricians are fairly self-regulating in their antibiotic prescribing practices and have developed their own norms and practices in which antibiotic prescribing is reserved for in-person encounters in the vast majority of cases."

They also note that the greater persistence of telehealth antibiotic prescribing for Lyme disease and skin and subcutaneous infections may be explained by clinicians feeling more comfortable making these diagnoses virtually. They suggest these conditions could be targets for future research and guideline development.
Aug 4 Pediatrics study

 

High rate of guideline-concordant antibiotic prescribing for UTIs

A study of women in the US Military Health System (MHS) found high concordance with guidelines for antibiotic treatment of uncomplicated urinary tract infections (UTIs), researchers reported today in JAMA Network Open.

Using healthcare claims data from the MHS Data Repository on women ages 18 to 50 who were treated for uncomplicated UTIs from October 2017 through September 2019, researchers from Johns Hopkins University School of Medicine and the Uniformed Services University assessed antibiotic prescribing patterns and concordance with antibiotic treatment guidelines from the Infectious Diseases Society of America (IDSA).

Previous studies have found that concordance with IDSA guidelines for UTIs ranges from 58.4% to 64.6%, with obstetricians and gynecologists more likely to prescribe a first-line antibiotic than other specialties.

Among 46,793 adult women (67.3% ages 18 to 34, 38.2% White) diagnosed as having an uncomplicated UTI, 91% received IDSA guideline-concordant antibiotic treatment. In comparison with obstetrics and gynecology, IDSA guideline-concordant treatment was more likely in internal medicine (adjusted odds ratio [aOR], 2.87; 95% confidence interval [CI], 2.73 to 3.03), family medicine (aOR, 1.81; 95% CI, 1.76 to 1.87), surgery (aOR, 1.51; 95% CI, 1.36 to 1.67), and emergency medicine (aOR, 1.36; 95% CI, 1.32 to 1.39) and less likely in urology (aOR, 0.40; 95% CI, 0.38 to 0.43). Compared with direct military care, private-sector care had lower concordance rates (aOR, 0.63; 95% CI, 0.62 to 0.64).

Of the 9% of women who received guideline-discordant treatment, the antibiotic overtreatment rate was 5.9%, with higher rates of overtreatment in emergency medicine and family medicine.

The study authors write, "Lower rates of IDSA guideline concordance were seen in obstetrics and gynecology and urology, which could potentially benefit from targeted antibiotic stewardship programs and policies that promote greater adherence to IDSA guidelines."
Aug 4 JAMA Netw Open study

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