1335. Accuracy of Outpatient Antibiotic Prescriptions for Urinary Tract Infection in Pediatric Ambulatory Care

Abstract

BackgroundAntimicrobial stewardship programs have typically focused on inpatient care, but antibiotics are frequently prescribed at pediatric ambulatory care centers. Ensuring accurate pediatric antibiotic dosing is important to optimize outcomes while minimizing adverse drug effects. Outpatient pharmacists often lack the resources to recommend optimal antibiotic dosing for pediatric infections. The primary objective was to evaluate the accuracy of antibiotic dose, frequency and formulation prescribed. The secondary objective was to describe the most commonly prescribed treatment durations.MethodsA retrospective review of electronic medical records was conducted at two suburban pediatric practices. Patients diagnosed with uncomplicated UTI over a two year period were identified using ICD-10 codes N39, R30 and R35. Patients 2 months-18 years were included if prescribed an oral antibiotic for the treatment of UTI. Data collected included baseline demographics, antibiotic, dose (mg and mg/kg), frequency, formulation, and duration. Antibiotic dose, frequency and formulation were considered accurate if they were consistent with clinical guidelines and tertiary dosing references, allowing for 10% rounding in weight-based doses.ResultsA total of 472 outpatient prescriptions met inclusion criteria. Overall, 24% of dosing regimens were found to be inaccurate. Patients were most commonly prescribed doses that were too low (54/118, 45%) or too high (41/118, 35%). Less frequently, doses exceeded the maximum total dose (9/118, 8%), were given at the wrong frequency (8/118, 7%), or the wrong dosage form was selected (6/118, 5%). Of the commonly prescribed antibiotics, dosing errors were most likely to occur with ciprofloxacin (24/27, 89%) and amoxicillin (33/64; 55%). The majority of patients completed a 10 day course of antibiotics (381, 80%), followed by 7 days (66, 13.9%). Durations of 3 days (20, 4.2%), 5 days (7, 1.5%) and 14 days (2, 0.4%) occurred less frequently.ConclusionErrors in antibiotic dosing occurred with nearly one in four prescriptions written for outpatient UTI from pediatric primary care centers. Durations were most commonly 10 days. Education and resources should be provided to outpatient pediatric providers to optimize antibiotic dosing.Disclosures All Authors: No reported disclosures