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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Antibiotic Prescribing for Children in United States Emergency Departments: 2009-2014
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Antibiotic Prescribing for Children in United States Emergency Departments: 2009-2014

机译：美国抗生素处方在美国急诊部门：2009-2014

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OBJECTIVES: To characterize and compare ambulatory antibiotic prescribing for children in US pediatric and nonpediatric emergency departments (EDs). METHODS: A cross-sectional retrospective study of patients aged 0 to 17 years discharged from EDs in the United States was conducted by using the 2009-2014 National Hospital Ambulatory Medical Care Survey ED data. We estimated the proportion of ED visits resulting in antibiotic prescriptions, stratified by antibiotic spectrum, class, diagnosis, and ED type ("pediatric" defined as 75% of visits by patients aged 0-17 years, versus "nonpediatric"). Multivariable logistic regression was used to determine factors independently associated with first-line, guideline-concordant prescribing for acute otitis media, pharyngitis, and sinusitis. RESULTS: In 2009-2014, of the 29 million mean annual ED visits by children, 14% (95% confidence interval [CI]: 10%-20%) occurred at pediatric EDs. Antibiotics overall were prescribed more frequently in nonpediatric than pediatric ED visits (24% vs 20%, P .01). Antibiotic prescribing frequencies were stable over time. Of all antibiotics prescribed, 44% (95% CI: 42%-45%) were broad spectrum, and 32% (95% CI: 30%-34%, 2.1 million per year) were generally not indicated. Compared with pediatric EDs, nonpediatric EDs had a higher frequency of prescribing macrolides (18% vs 8%, P .0001) and a lower frequency of first-line, guideline-concordant prescribing for the respiratory conditions studied (77% vs 87%, P .001). CONCLUSIONS: Children are prescribed almost 7 million antibiotic prescriptions in EDs annually, primarily in nonpediatric EDs. Pediatric antibiotic stewardship efforts should expand to nonpediatric EDs nationwide, particularly regarding avoidance of antibiotic prescribing for conditions for which antibiotics are not indicated, reducing macrolide prescriptions, and increasing first-line, guideline-concordant prescribing.
机译：目的：为美国儿科和非经济症急诊部门（EDS）的儿童进行表征和比较动态抗生素规定。方法：采用2009 - 2014年国家医院外国医疗护理调查ED数据进行了从美国出境0至17岁的患者的横断面回顾性研究。我们估计，通过抗生素谱，类，诊断和ED类型（“儿科”定义为＆GT的抗生素前列的抗生素处方的比例。患者患者为0-17岁的患者的75％，与“非经济学”）。多变量逻辑回归用于确定与一线独立相关的因素，对急性中耳炎，咽炎和鼻窦炎处方的指导协调剂。结果：2009 - 2014年，儿童的2900万平均年度ED访问，14％（95％置信区间[CI]：10％-20％）发生在儿科埃德斯。抗生素总体上的常见于儿科申报（24％vs 20％，P <0.01）更频繁地规定。抗生素规定频率随着时间的推移稳定。在规定的所有抗生素中，一般不指明44％（95％CI：42％-45％），32％（95％CI：30％-34％，每年210％）。与儿科EDS相比，非发育EDS具有较高的处方大啰啉频率（18％vs 8％，P＆ .0001）和较低的一线频率，对所研究的呼吸系统的指导协调态度（77％VS 87 ％，p＆ .001）。结论：儿童每年都在EDS中规定近700万抗生素处方，主要是在非经济学期间。儿科抗生素管道努力应扩大全国范围内，特别是关于避免抗生素，对未指出抗生素，减少大环内德处方以及增加一线的指南协调结果的条件。

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