Inappropriate ceftriaxone use in outpatient acute respiratory infection management

King, Laura; Talley, Pamela; Kainer, Marion A.; Evans, Christopher; Adre, Cullen; Hicks, Lauri A.; Fleming-Dutra, Katherine E.

doi:10.1017/ice.2019.21

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Third-generation cephalosporins, such as ceftriaxone, are broad-spectrum antibiotics and are frequently prescribed in pediatrics despite a lack of first-line indications [ 11 ]. Preserving the use of such agents to treat serious and resistant bacterial infections [ 12 ] and reducing unnecessary broad-spectrum and parenteral antibiotic use are key to optimizing treatment of infectious conditions and to minimizing the risk of antibiotic-associated adverse events and development of antibiotic resistance.…”

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confidence: 99%

Parenteral Antibiotic Use Among Ambulatory Children in United States Children’s Hospital Emergency Departments

Howard

Thurm

Dantuluri

et al. 2020

Open Forum Infectious Diseases

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Background Despite increasing recognition of the importance of optimal antibiotic selection and expansion of antimicrobial stewardship activities to ambulatory settings, few studies have examined the frequency of parenteral antibiotic use among ambulatory children. We assessed the prevalence and patterns of parenteral antibiotic administration among ambulatory children in pediatric emergency departments (EDs). Methods We conducted a cross-sectional assessment of parenteral antibiotic use among ambulatory children aged 0–18 years in 49 US children’s hospital EDs in 2018. We assessed the prevalence rates of parenteral antibiotic use and stratified these by patient-, clinic-, and hospital-level characteristics. We also assessed the prevalence of use of specific antibiotics by age and diagnosis category. Among encounters associated with an infection diagnosis, we identified factors associated with parenteral antibiotic use using multivariable logistic regression. Results Among 3 452 011 ambulatory ED encounters in 2018, parenteral antibiotics were administered in 62 648 (1.8%). The highest proportion of parenteral antibiotic use occurred in the 15–18-year age group (3.3%) and among encounters in children with complex chronic conditions (8.9%) and with primary diagnoses of neoplasms (36%). Ceftriaxone was the most commonly administered parenteral antibiotic (61%). In multivariable analysis, several factors including age ≤2 months, White race, private insurance, complex chronic conditions, digestive and genitourinary system diseases, and encounters attributed to emergency medicine providers were significantly associated with higher odds of parenteral antibiotic use. Conclusions This study demonstrates substantial variability in the frequency of parenteral antibiotic administration by age and diagnosis in the ambulatory ED setting and highlights potential opportunities to target stewardship activities.

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confidence: 99%

Parenteral Antibiotic Use Among Ambulatory Children in United States Children’s Hospital Emergency Departments

Howard

Thurm

Dantuluri

et al. 2020

Open Forum Infectious Diseases

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“…In a previous study performed during COVID-19 in Egypt, some of the surveyed community pharmacists reported dispensing a non-appropriate dose of ceftriaxone (Elsayed et al, 2021 ). Levofloxacin and ceftriaxone wide and irrational use before and during the pandemic in both the inpatient and the outpatient settings could have contributed to the increased antimicrobial resistance (King et al, 2019 ; Medic et al, 2023 ). Physicians accepted all of the DTC-trained clinical pharmacists-led recommendations, in line with a previous study (Malani et al, 2013 ).…”

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confidence: 99%

The pharmacists’ interventions after a Drug and Therapeutics Committee (DTC) establishment during the COVID-19 pandemic

Kassem,

Al Meslamani,

Elmaghraby

et al. 2024

Journal of Pharmaceutical Policy and Practice

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Changes in outpatient antibiotic prescribing for acute respiratory illnesses, 2011 to 2018

King

Tsay

Hicks

et al. 2021

ASHE

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Objectives: To describe acute respiratory illnesses (ARI) visits and antibiotic prescriptions in 2011 and 2018 across outpatient settings to evaluate progress in reducing unnecessary antibiotic prescribing for ARIs. Design: Cross-sectional study. Setting and patients: Outpatient medical and pharmacy claims captured in the IBM MarketScan commercial database, a national convenience sample of privately insured individuals aged <65 years. Methods: We calculated the annual number of ARI visits and visits with oral antibiotic prescriptions per 1,000 enrollees overall and by age category, sex, and setting in 2011 and 2018. We compared these and calculated prevalence rate ratios (PRRs). We adapted existing tiered-diagnosis methodology for International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Results: In our study population, there were 829 ARI visits per 1,000 enrollees in 2011 compared with 760 ARI visits per 1,000 enrollees in 2018. In 2011, 39.3% of ARI visits were associated with ≥1 oral antibiotic prescription versus 36.2% in 2018. In 2018 compared with 2011, overall ARI visits decreased 8% (PRR, 0.92; 99.99% confidence interval [CI], 0.92–0.92), whereas visits with antibiotic prescriptions decreased 16% (PRR, 0.84; 99.99% CI, 0.84–0.85). Visits for antibiotic-inappropriate ARIs decreased by 9% (PRR, 0.91; 99.99% CI, 0.91–0.92), and visits with antibiotic prescriptions for these conditions decreased by 32% (PRR, 0.68; 99.99% CI, 0.67–0.68) from 2011 to 2018. Conclusions: Both the rate of antibiotic prescriptions per 1,000 enrollees and the percentage of visits with antibiotic prescriptions decreased modestly from 2011 to 2018 in our study population. These decreases were greatest for antibiotic-inappropriate ARIs; however, additional reductions in inappropriate antibiotic prescribing are needed.

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Inappropriate ceftriaxone use in outpatient acute respiratory infection management

Abstract: Financial support. No financial support was provided relevant to this article. Conflicts of interest. A.M. reports consulting for Becton Dickinson. S.E.C. reports consulting for Theravance and Novartis. All other authors report no conflicts of interest relevant to this article.

Cited by 3 publications

References 8 publications

Parenteral Antibiotic Use Among Ambulatory Children in United States Children’s Hospital Emergency Departments

Parenteral Antibiotic Use Among Ambulatory Children in United States Children’s Hospital Emergency Departments

The pharmacists’ interventions after a Drug and Therapeutics Committee (DTC) establishment during the COVID-19 pandemic

Changes in outpatient antibiotic prescribing for acute respiratory illnesses, 2011 to 2018

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