624 BROAD-SPECTRUM ANTIBIOTIC PRESCRIBING PATTERNS IN OUTPATIENT PEDIATRIC URINARY TRACT INFECTION

Abstract

You have accessJournal of UrologyPediatrics: Imaging (Genital & Urinary Tract)/Infections and Vesicoureteral Reflux1 Apr 2012624 BROAD-SPECTRUM ANTIBIOTIC PRESCRIBING PATTERNS IN OUTPATIENT PEDIATRIC URINARY TRACT INFECTION Hillary Copp, Jenny Yiee, Alexandria Smith, Janet Hanley, Christopher Saigal, and Urologic Diseases in Americab Hillary CoppHillary Copp San Francisco, CA More articles by this author , Jenny YieeJenny Yiee Los Angeles, CA More articles by this author , Alexandria SmithAlexandria Smith Santa Monica, CA More articles by this author , Janet HanleyJanet Hanley Santa Monica, CA More articles by this author , Christopher SaigalChristopher Saigal Los Angeles, CA More articles by this author , and Urologic Diseases in Americab More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.702AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ambulatory care physicians often prescribe broad-spectrum antibiotics for the treatment of pediatric urinary tract infection (UTI). However, most UTIs are susceptible to narrower-spectrum alternatives. Few studies have examined factors that are associated with broad-spectrum antibiotic prescribing practices for pediatric UTI. METHODS We examined antibiotics prescribed for UTIs in children <18 years using Innovus i3, a claims database, which contains longitudinal data from 2002-2007. Amoxicillin-clavulanate, quinolones, macrolides, and second- and third-generation cephalosporins were classified as broad-spectrum antibiotics. We evaluated trends in broad-spectrum prescribing and performed multivariable logistic regression to assess for factors associated with broad-spectrum antibiotic use. RESULTS Broad-spectrum antibiotics were prescribed in 29% of the 40,096 UTI visits identified. There was an increase in the overall prescription of broad-spectrum antibiotics from 28% to 30% (p<0.05) during the study period. On multivariable analysis age (<2 years: OR 1.6, 95%CI 1.5-1.8 and 2-5 years: OR 1.1, 95%CI 1.0-1.2 compared with age 13-17 years); patient sex (male: OR 1.1, 95%CI 1.0-1.2); history of UTI (OR 1.2, 95%CI 1.2-1.3); recent hospitalization (OR 1.3, 95%CI 1.2-1.4); antimicrobial exposure within 30 days prior to UTI (OR 1.1, 95%CI 1.0-1.2); presence of congenital urologic anomaly (OR 1.2, 95%CI 1.1-1.3); and physician specialty (pediatricians: OR 1.9, 95%CI 1.8-2.0 and emergency room physicians: OR 1.4, 95%CI 1.3-1.5 compared with family medicine/internal medicine physicians) were independent predictors of broad-spectrum antibiotic prescribing. CONCLUSIONS Broad-spectrum antibiotic use for the treatment of pediatric UTI rose in this insured population. Physician specialty significantly influenced antibiotic prescription. Factors predisposing a patient to resistant UTIs were associated with prescription of broad-spectrum antibiotics (recurrent UTI, recent hospitalization, recent antimicrobial exposure, and congenital urologic anomalies). Analysis of data that can account for illness severity and local antibiotic resistance patterns is necessary to truly assess the appropriateness of broad-spectrum antibiotic prescribing practices. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e253-e254 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hillary Copp San Francisco, CA More articles by this author Jenny Yiee Los Angeles, CA More articles by this author Alexandria Smith Santa Monica, CA More articles by this author Janet Hanley Santa Monica, CA More articles by this author Christopher Saigal Los Angeles, CA More articles by this author Urologic Diseases in Americab More articles by this author Expand All Advertisement Advertisement Loading ...