{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:42:31Z","timestamp":1790145751667,"version":"4.0.1"},"reference-count":48,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,2,1]]},"abstract":"<jats:sec>\n                  <jats:title\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES:<\/jats:title>\n                  <jats:p>To characterize and compare ambulatory antibiotic prescribing for children in US pediatric and nonpediatric emergency departments (EDs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>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\u20132014 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 (\u201cpediatric\u201d defined as &amp;gt;75% of visits by patients aged 0\u201317 years, versus \u201cnonpediatric\u201d). Multivariable logistic regression was used to determine factors independently associated with first-line, guideline-concordant prescribing for acute otitis media, pharyngitis, and sinusitis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>In 2009\u20132014, of the 29 million mean annual ED visits by children, 14% (95% confidence interval [CI]: 10%\u201320%) occurred at pediatric EDs. Antibiotics overall were prescribed more frequently in nonpediatric than pediatric ED visits (24% vs 20%, P &amp;lt; .01). Antibiotic prescribing frequencies were stable over time. Of all antibiotics prescribed, 44% (95% CI: 42%\u201345%) were broad spectrum, and 32% (95% CI: 30%\u201334%, 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 &amp;lt; .0001) and a lower frequency of first-line, guideline-concordant prescribing for the respiratory conditions studied (77% vs 87%, P &amp;lt; .001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2018-1056","type":"journal-article","created":{"date-parts":[[2019,1,8]],"date-time":"2019-01-08T13:31:43Z","timestamp":1546954303000},"source":"Crossref","is-referenced-by-count":80,"title":["Antibiotic Prescribing for Children in United States Emergency Departments: 2009\u20132014"],"prefix":"10.1542","volume":"143","author":[{"given":"Nicole M.","family":"Poole","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington;"},{"name":"Seattle Children's Research Institute, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Boston Combined Residency Program in Pediatrics, Boston Children's Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E.","family":"Fleming-Dutra","sequence":"additional","affiliation":[{"name":"Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauri A.","family":"Hicks","sequence":"additional","affiliation":[{"name":"Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam L.","family":"Hersh","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew P.","family":"Kronman","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2019,2,1]]},"reference":[{"issue":"160","key":"2021121012435032200_B1","first-page":"1","article-title":"Reasons for emergency room use among US children: National Health Interview Survey, 2012.","author":"Gindi","year":"2014","journal-title":"NCHS Data Brief"},{"issue":"2","key":"2021121012435032200_B2","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1097\/PEC.0b013e3180302c22","article-title":"Emergency care for children in pediatric and general 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