Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection: A National, Ambulatory Assessment of Broad-Spectrum Antibiotic Use From 1998-2007

Sunday, October 3, 2010: 8:10 AM
Yerba Buena Salon 9 (San Francisco Marriott Marquis)
Hillary L. Copp, MD, MS, Department of Urology, UCSF, San Francisco, CA, Daniel Shapiro, Institute for Health Policy Studies, UCSF, San Francisco, CA and Adam Hersh, MD, PhD, Pediatric Infectious Diseases, UCSF, San Francisco, CA

Purpose: Urinary tract infection (UTI) affects up to 3.5% of children in the United States annually and represents a major source of exposure to antibiotics in the pediatric population.  Studies in the adult literature demonstrate an increase in the use of broad-spectrum antibiotics for UTI over time. No similar evaluation of national, ambulatory antibiotic prescribing patterns for children with UTI has been performed.  Our objectives were to investigate patterns of outpatient antibiotic use for pediatric UTI and to identify factors associated with broad spectrum antibiotic prescribing.

Methods: We examined antibiotics prescribed for UTI for all children <18 years from 1998-2007 using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.  Amoxicillin-clavulanate, quinolones, and second and third generation cephalosporins were classified as broad-spectrum antibiotics. We evaluated trends in broad-spectrum antibiotic prescribing patterns and performed multivariate logistic regression to identify factors associated with broad-spectrum antibiotic usage.

Results: There were roughly 1.6 million pediatric UTI visits per year with no increase over time (p=0.62).  Trimethoprim-sulfamethoxazole was the most commonly prescribed antibiotic (49% of visits).  One third of UTI visits were prescribed broad-spectrum antibiotics.  There was no increase in overall use of broad-spectrum antibiotics during the study period (p=0.67); however, use of third generation cephalosporins increased from 12% to 25% of antibiotic prescriptions for pediatric UTI (p=0.02).  Children less than 1 year (OR 5.4, 95%CI 2.1-13.6 compared with children 13-18 years) had increased odds of being prescribed broad-spectrum antibiotics.  From 2003-2007 children less than 1 year (OR 9.5, 95%CI 2.9-31.7 compared with children 13-18 years), females (OR 3.5, 95% CI 1.5-8.1) and the presence of fever ≥ 100.4 (OR 3.0, 95% CI 1.0-8.8) were independent predictors of broad-spectrum antibiotic prescribing. Race, region, insurance status, and physician specialty were not associated with antibiotic selection.

Conclusion: Ambulatory care physicians commonly prescribe broad spectrum antibiotics for the treatment of UTI in children, especially for febrile infants where complicated infections are more likely.  However, the doubling in use of third generation cephalosporins suggests that opportunities exist to promote more judicious antibiotic prescribing since most pediatric UTIs are susceptible to narrower-spectrum alternatives.

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