{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T12:23:00Z","timestamp":1791116580515,"version":"4.1.0"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n In the US, 50% of all pediatric outpatient antibiotics prescribed are unnecessary or inappropriate. Less is known about the appropriateness of pediatric outpatient antibiotic prescribing.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To identify the overall percentage of outpatient antibiotic prescriptions that are optimal according to guideline recommendations for first-line antibiotic choice and duration.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study obtained data on any clinical encounter for a patient younger than 20 years with at least 1 outpatient oral antibiotic, intramuscular ceftriaxone, or penicillin prescription filled in the state of Tennessee from January 1 to December 31, 2022, from IQVIA\u2019s Longitudinal Prescription Claims and Medical Claims databases. Each clinical encounter was assigned a single diagnosis corresponding to the lowest applicable tier in a 3-tier antibiotic tier system. Antibiotics prescribed for tier 1 (nearly always required) or tier 2 (sometimes required) diagnoses were compared with published national guidelines. Antibiotics prescribed for tier 3 (rarely ever required) diagnoses were considered to be suboptimal for both choice and duration.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcome was the percentage of optimal antibiotic prescriptions consistent with guideline recommendations for first-line antibiotic choice and duration. Secondary outcomes were the associations of optimal prescribing by diagnosis, suboptimal antibiotic choice, and patient- and clinician-level factors (ie, age and Social Vulnerability Index) with optimal antibiotic choice, which were measured by odds ratios (ORs) and 95% CIs calculated using a multivariable logistic regression model.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 506\u202f633 antibiotics were prescribed in 488\u202f818 clinical encounters (for 247\u202f843 females [50.7%]; mean [SD] age, 8.36 [5.5] years). Of these antibiotics, 21\u202f055 (4.2%) were for tier 1 diagnoses, 288\u202f044 (56.9%) for tier 2 diagnoses, and 197\u202f660 (39.0%) for tier 3 diagnoses. Additionally, 194\u202f906 antibiotics (38.5%) were optimal for antibiotic choice, 259\u202f786 (51.3%) for duration, and 159\u202f050 (31.4%) for both choice and duration. Acute otitis media (AOM) and pharyngitis were the most common indications, with 85\u202f635 of 127\u202f312 (67.3%) clinical encounters for AOM and 42\u202f969 of 76\u202f865 (55.9%) clinical encounters for pharyngitis being optimal for antibiotic choice. Only 257 of 4472 (5.7%) antibiotics prescribed for community-acquired pneumonia had a 5-day duration. Optimal antibiotic choice was more likely in patients who were younger (OR, 0.98; 95% CI, 0.98-0.98) and were less socially vulnerable (OR, 0.84; 95% CI, 0.82-0.86).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This cross-sectional study found that less than one-third of antibiotics prescribed to pediatric outpatients in Tennessee were optimal for choice and duration. Four stewardship interventions may be targeted: (1) reduce the number of prescriptions for tier 3 diagnoses, (2) increase optimal prescribing for AOM and pharyngitis, (3) provide clinician education on shorter antibiotic treatment courses for community-acquired pneumonia, and (4) promote optimal antibiotic prescribing in resource-limited settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.37409","type":"journal-article","created":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T11:32:26Z","timestamp":1727955146000},"page":"e2437409","source":"Crossref","is-referenced-by-count":28,"title":["Optimal Pediatric Outpatient Antibiotic Prescribing"],"prefix":"10.1001","volume":"7","author":[{"given":"Brittany J.","family":"Lehrer","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glodi","family":"Mutamba","sequence":"additional","affiliation":[{"name":"Healthcare-Associated Infections and Antimicrobial Resistance Program of the Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie A.","family":"Thure","sequence":"additional","affiliation":[{"name":"Healthcare-Associated Infections and Antimicrobial Resistance Program of the Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Evans","sequence":"additional","affiliation":[{"name":"Healthcare-Associated Infections and Antimicrobial Resistance Program of the Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam L.","family":"Hersh","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritu","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie E.","family":"Katz","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, 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