Antibiotic prescribing practices for acute otitis media and community-acquired pneumonia in a pediatric emergency department.

Background: Recent evidence-based pediatric guidelines recommend a 5-day course of amoxicillin as first-line therapy for uncomplicated acute otitis media (AOM) in children 2 years and older and community-acquired pneumonia (CAP). The objective of this study was to assess the guideline consistency of antibiotic prescriptions for AOM and CAP in a Canadian quaternary care pediatric emergency department (ED) and identify opportunities to improve antibiotic prescribing.

Methods: We retrospectively reviewed antibiotic prescriptions for patients 0 to 18 years old discharged from the ED with a diagnosis of AOM or CAP from September 2022 through September 2023. Clinical information and prescription data were extracted from the electronic medical record. Analysis was completed using descriptive statistics.

Results: Of 2313 retrieved records, 1143 (85%) cases of AOM and 753 (75%) cases of CAP met the inclusion criteria. Six hundred and eighty-eight (60%) AOM prescriptions and 140 (19%) CAP prescriptions were guideline-consistent. Prescriptions were not guideline-consistent largely because of antibiotic duration (62% for AOM-67% attributable to excess duration; 93% for CAP- > 99% attributable to excess duration), followed by antibiotic dosing interval (31% for AOM; 22% for CAP), antibiotic selection (17% for AOM; 6% for CAP) and antibiotic dose (8% for AOM; 2% for CAP). Of 293 patients eligible for deferred prescriptions for AOM based on age and clinical presentation, only 52% received them.

Conclusions: Most guideline-discordant prescriptions for both AOM and CAP resulted from prolonged antibiotic duration. Given the frequency of these diagnoses, effective interventions to improve guideline consistency would have a significant impact at a population level.