Antibiotic prescribing in pediatric practices declined 73% amid pandemic

07 October 2021

2 minutes reading

Source/Revelations

Source:

Dutcher L, et al. Summary 162. Presented at: IDWeek;Sept. Oct 29. 3, 2021 (virtual meeting).

disclosures:
Dutcher reports no relevant financial disclosures.

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Researchers noted a significant reduction in antibiotic prescriptions at pediatric primary care centers within the Children’s Hospital of Philadelphia network after the onset of the COVID-19 pandemic.

Lauren Dutcher, MD, an instructor of medicine at the University of Pennsylvania School of Medicine, said this reduction was mainly due to a decrease in prescriptions during encounters with respiratory infections (RTIs). She presented the findings at the IDWeek virtual meeting.

Source: Dutcher L, et al. Summary 162. Presented on: IDWeek;Sept. Oct 29. 3, 2021 (virtual meeting).

Dutcher and colleagues conducted a retrospective cohort study to examine the impact of the COVID-19 pandemic, including associated public health measures and changes in healthcare, on antibiotic prescribing in 27 practices.

The researchers compared trends in antibiotic prescribing from April 2019 to December 2019 with trends over the same period in 2020. They reported that the total number of antibiotic prescriptions decreased by 73%, from 69,327 prescriptions in 2019 to 18,935 prescriptions in 2020 for 87.3. % of the total reduction in the total number of antibiotic prescriptions, Dutcher said. During these encounters, antibiotic prescriptions dropped from 50,876 in 2019 to 6,890 in 2020.

“I suspect this is probably due in large part to a reduction in circulating viral respiratory infections rather than a reduction in health-seeking behavior,” Dutcher said. “We initially saw a decrease in healthcare seeking behavior as evidenced by an immediate and substantial decrease in total visit volume, but when we saw visit volume return to baseline relatively quickly, we did not see that in RTI specific visits, which suggests that circulating RTIs remained low.”

The researchers estimate that there were 35.7 antibiotic prescriptions per 1,000 patients in April 2019 compared to 8.1 antibiotic prescriptions per 1,000 patients in April 2020 (77% reduction) and 8.8 antibiotic prescriptions per 1,000 patients in April 2021 (75% reduction). The researchers identified similar trends during RTI encounters. By contrast, prescription trends during encounters for UTIs and skin and soft tissue infections “remained relatively flat even after the onset of the pandemic,” Dutcher said. The total number of antibiotic prescriptions appeared to rise in May and June this year, she added.

“We saw that a minority of prescriptions were prescribed during telemedicine visits during the pandemic,” Dutcher said. “This is important because there is some literature suggesting that in primary care and emergency care there can sometimes be more prescription, especially more inappropriate prescribing, with telemedicine. But there was no excessive representation of telemedicine visits in our study.”

Perspective

Back upstairs

Gary C. Steven, MD, PhD, CPI, FAAAAI, FACAAI, FAPCR

Interestingly, my anecdotal experience is remarkably similar: a 72% reduction in antibiotic prescriptions for RTI in the first full year of the pandemic (April 1, 2020 to April 1, 2021) compared to the average of the previous 5 years. Unlike this much larger pediatric study, I see both children and adults in my solo, independent, community-based allergy practice. However, rather than attributing the reduction to a decrease in the number of encounters, the reduction in antibiotics for RTIs was much more likely due to non-pharmacological mitigating measures such as masking and distancing, as my number of patient encounters did not decrease. To encourage allergen immunotherapy and asthma biologic patients to stay in therapy, we’ve strived to keep the waiting room empty by scheduling injection appointments rather than walking in and quickly transitioning to telemedicine. I have made more than 5,100 television visits since the start of the pandemic, an increase of about 3% in the total patient volume. I attribute this to the ease with which patients can participate in television visits, as well as the drastically reduced no-show rate; less than 10% of my personal no-show rate, which sometimes reached as much as 20% per day.

Gary C. Steven, MD, PhD, CPI, FAAAAI, FACAAI, FAPCR

Owner and CEO, Allergy, Asthma & Sinus Center Greenfield, Wis.

disclosures: Steven does not report any relevant financial disclosures.

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