title: Risk Factors for Outpatient Use of Antibiotics in Children with Acute Respiratory Illnesses.
abstract: Antibiotics for acute respiratory illness (ARI) constitute most pediatric medication use and contribute to the emergence of antimicrobial resistance. We investigated antibiotic prescription risk factors for ARI in pediatric clinics and clinical follow-up in individuals prescribed and not prescribed antibiotics.
  
  
  
  In this observational study, we enrolled children ages 2 to 17 years old presenting with ARI with fever to two academic pediatric primary care outpatient clinics during influenza season 2013-2014. We collected information on demographics, initial symptoms, medical conditions, laboratory tests, discharge diagnoses, treatments, and 30 days of follow-up medical encounters. Factors associated with antibiotic prescription receipt were evaluated using logistic regression.
  
  
  
  Of 206 consented and enrolled children, 59 (29%) were prescribed antibiotics, 51 of 59 (86%) for indicated diagnoses: 34 for streptococcal pharyngitis, 15 for acute otitis media (AOM), and 2 for pneumonia. Discharge diagnoses were the only factors independently associated with an antibiotic prescription. Of children prescribed/not prescribed an antibiotic, 17%/17% received follow-up telephone calls and 27%/17% had follow-up visits related to ARI within 30 days. Two children with AOM were prescribed a second antibiotic during follow-up, and one developedClostridium difficilecolitis. Eighteen of 206 (9%) additional children were prescribed antibiotics within 30 days for ARI symptoms, 17 for streptococcal pharyngitis, AOM, pneumonia, or sinusitis; one was prescribed antibiotics for influenza-like illness.
  
  
  
  Among study children 2 to 17 years old with outpatient ARI, 29% were prescribed antibiotics at the initial visit and another 9% were prescribed antibiotics during the 30-day follow-up (most were for appropriate indications). Further decreasing antibiotic use in similar settings will likely require wider implementation of watchful waiting for AOM, a change in guidelines for pharyngitis management, and/or reductions in these diseases.
authors.affiliation: From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Sophie R
authors.initials: SR
authors.lastname: Zhao
authors.affiliation: From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
authors.affiliation: From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Barron L
authors.initials: BL
authors.lastname: Patterson
authors.affiliation: From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Mace
authors.affiliation: From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Dayna
authors.initials: D
authors.lastname: Wyatt
authors.affiliation: From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Yuwei
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: H Keipp
authors.initials: HK
authors.lastname: Talbot
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010033:Otitis Media / Q000188:drug therapy*; D010612:Pharyngitis / Q000188:drug therapy*; D011014:Pneumonia / Q000188:drug therapy*; D012307:Risk Factors; D013714:Tennessee
chemical_list: D000900:Anti-Bacterial Agents