1352. Pediatric azithromycin prescriptions in a healthcare system from 2016-2018

Abstract

BackgroundIn 2017, the Centers for Disease Control and Prevention (CDC) estimated that 30% of all antibiotics prescribed in outpatient clinics are unnecessary, with children receiving more antibiotics than any other age group. Among those antibiotics being prescribed, azithromycin is one of the most commonly prescribed antibiotics.MethodsWe reviewed antimicrobial prescribing data of children 0 to 19 years of age who visited West Virginia University (WVU) Health system which is the flagship institution for the state. We reviewed information of patients who were prescribed azithromycin by healthcare providers between January 2016 and December 2018. We included prescribing data from urgent care centers, outpatient clinics and emergency departments. The primary visit diagnosis associated with the visit was reviewed.ResultsDuring the study period there were 29,983 visits identified during which antibiotics were prescribed and azithromycin was prescribed in 40.6% of those visits. The majority of visits occurred between the months of October through February (54.4%), with December having the most visits. There were 11,934 unique patients identified and only 26.5% of these patients were marked as allergic to penicillin (PCN) or amoxicillin. The distribution of the age groups for azithromycin prescriptions is shown in figure 1. The age group of 11-19 years had the highest azithromycin prescription rate (38.7%) and the most common diagnosis for this group was pharyngitis. The distribution of the common diagnoses associated with azithromycin prescriptions can be seen in figure 2 and acute otitis media (AOM) was the most common diagnosis (23.6%).Figure 1- Age distribution of children who received azithromycin prescriptions during the study period Figure 2- Distribution of diagnoses associated with azithromycin prescriptions ConclusionAcute otitis media and pharyngitis accounted for almost half of the diagnoses associated with azithromycin prescriptions. Treatment guidelines for both conditions recommend PCN-based therapy as first-line treatment unless there is a history of PCN allergy. Only a quarter of the patients had allergy documented to PCN or amoxicillin and, therefore, azithromycin would be considered a suboptimal antimicrobial choice. These results provide us with a stewardship opportunity to nudge providers to select appropriate antimicrobial based on diagnosis and history of allergy.Disclosures All Authors: No reported disclosures