PRS8 - Use of Antibiotics for Children with Acute Respiratory Tract Infections and Its Effects on Outpatient Revisits

Abstract

Antibiotics are the recommended treatment for acute respiratory tract infections (ARTIs) in children. Inappropriate and possible overuse of antibiotics is a concern within pediatric settings. To effectively treat ARTIs, documenting the outcomes from antibiotic use is useful evidence for making treatment decisions. We document filled antibiotic prescriptions and antibiotic class prescribed for ARTIs in outpatient pediatric settings. We estimate the effects of the antibiotic class used on the likelihood of revisits within 28 days. Optum Insight Clinformatics claims data, both medical and pharmacy claims from 2011-2013, were used to analyze prescribed antibiotics (N=34,822) and filled prescriptions for children (<18 years old) diagnosed with ARTIs. Treatment episode of care was defined around the date of the first ARTI visit (+/- 6 months) and antibiotic prescription filled within 3 days after the ARTI visit was defined as treatment from that visit. The class of antibiotic and time to fill the prescription were both investigated as factors affecting revisit risk. A multivariable logistic regression was used to identify demographic and clinical factors associated with initiating a revisit within 28 days after using the antibiotic. When prescribed an antibiotic for an ARTI visit, only 18% filled the prescription within 3 days of their visit. Not filling within 3 days more than doubles the risk of returning for a revisit within 28 days. Penicillins made up 55% of the prescribed antibiotics and thus were the largest class of antibiotics filled. Antibiotic class has no impact on the likelihood of initiating a revisit within 28 days. 9% had adverse events due to antibiotics. Not filling an antibiotic prescription within 3 days poses a higher risk for a return visit. However, the class of antibiotic does not affect the likelihood of returning for a revisit within 28 days.