Pediatric Azithromycin Prescriptions in a Healthcare System from 2016-2018

Skylar Petrone*, Lisa Garavaglia PharmD, Shipra Gupta M.D.
Department of Pediatrics, Division of Pediatric Infectious Diseases, J.W. Ruby Memorial Hospital, Morgantown, WV 26505

Presentation Category: Health Sciences (Poster presentation)

Student’s Major: Exercise Physiology

Background: In 2017, the Centers for Disease Control and Prevention (CDC) estimated that 30% of all antibiotics prescribed in outpatient clinics are unnecessary. Among those antibiotics being prescribed, azithromycin is one of the most commonly prescribed antibiotics, with children receiving more antibiotics than any other age group. Methods: We reviewed azithromycin prescribing data of children 0 to 19 years of age who visited West Virginia University (WVU) Health system between January 2016 and December 2018. The primary visit diagnosis associated with the visit was reviewed. Results: There were 29,983 visits identified during which antibiotics were prescribed during the study period and azithromycin was prescribed in 40.6% of those visits. There were 11,934 unique patients identified and only 26.5% of these patients weremarked as allergic to penicillin (PCN) or amoxicillin. 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. Acute otitis media (AOM) was the most common diagnosis (23.6%). Conclusion: Acute 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 an appropriate antimicrobial based on diagnosis and history of allergy.

Funding: Not funded

Program/mechanism supporting research/creative efforts: WVU's Research Apprenticeship Program (RAP) & accompanying HONR 297-level course