{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:34:20Z","timestamp":1786365260660,"version":"build-2736575974"},"reference-count":14,"publisher":"The Pediatric Pharmacy Association","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n OBJECTIVE<\/jats:title>\n To assess prescribing patterns following an oral cephalosporin formulary change and the implementation of a legacy medication alternative in the electronic medical record to discourage prescribing cefdinir when de-escalating intravenous ceftriaxone to an enteral antibiotic in pediatric patients.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This was a single-center, retrospective cohort study of hospitalized pediatric patients who received at least 1 dose of ceftriaxone de-escalated to an enteral antibiotic for the treatment of community-acquired pneumonia, upper respiratory tract infection, or urinary tract infection. Patients from a 6-month period post-formulary change were compared with a historical cohort from the same timeframe, 1 year prior. The primary outcome was the change in cefdinir prescribing. Secondary outcomes included the rate of optimal antibiotic de-escalation before and after the interventions, hospital length of stay, and hospital re-encounter rates.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 134 patients were included. Cefdinir prescribing occurred in 44% and 34% (p = 0.287) of patients pre- and post-intervention, respectively. Optimal enteral antibiotic de-escalation occurred in 46 (62%) patients pre-intervention and 43 (72%) post-intervention (p = 0.245). Rates of optimal de-escalation were lowest for patients treated for urinary tract infection (< 60% in both cohorts), with cefdinir used in 48% of these cases. Hospital re-encounters occurred in 6 (8%) patients pre-intervention and 0 (0%) post-intervention (p = 0.035). Median length of stay was significantly reduced (p = 0.038) post-intervention, driven by a 1-day reduction in patients treated for community-acquired pneumonia (p = 0.013).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n After the formulary changes involving cefdinir, there was no significant decrease in cefdinir use or in optimal de-escalation rates. There were significantly lower hospital re-encounters and shorter lengths of stay, though further studies are needed to validate these findings.<\/jats:p>\n <\/jats:sec>","DOI":"10.5863\/jppt-25-00069","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:26:19Z","timestamp":1786364779000},"page":"509-515","source":"Crossref","is-referenced-by-count":0,"title":["Impact of a Formulary Change and Implementation of a Legacy Medication Alternative in the Electronic Medical Record on Antibiotic Prescribing In Children"],"prefix":"10.5863","volume":"31","author":[{"given":"Hailey","family":"Kemp","sequence":"first","affiliation":[{"name":"Department of Pharmacy (HK), University of Florida Health Shands Hospital, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalen B.","family":"Manasco","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (KBM), University of Florida Health Children\u2019s Hospital, Gainesville, FL"},{"name":"Department of Pharmacy Education and Practice (KBM), University of Florida College of Pharmacy, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3883","reference":[{"issue":"8","key":"JPPT-25-00069-b01","series-title":"Clin Infect Dis","first-page":"e226","article-title":"Appropriateness of antibiotic prescribing in United States children\u2019s hospitals: a national point prevalence survey","volume":"71","author":"Tribble","year":"2020","unstructured":"Tribble AC, Lee BR, Flett KB, et al. Appropriateness of antibiotic prescribing in United States children\u2019s hospitals: a national point prevalence survey. Clin Infect Dis. 2020;71(8):e226\u2013e234."},{"issue":"11","key":"JPPT-25-00069-b02","series-title":"Pediatr Rev","first-page":"510","article-title":"Cephem antibiotics: wise use today preserves cure for tomorrow","volume":"34","author":"Parker","year":"2013","unstructured":"Parker S, Mitchell M, Child J. Cephem antibiotics: wise use today preserves cure for tomorrow. Pediatr Rev. 2013;34(11):510\u2013524."},{"issue":"7","key":"JPPT-25-00069-b03","series-title":"Clin Infect Dis","article-title":"The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America","volume":"53","author":"Bradley","year":"2011","unstructured":"Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7)."},{"issue":"2","key":"JPPT-25-00069-b04","series-title":"Pediatrics","first-page":"e2020012138","article-title":"Contemporary management of urinary tract infection in children","volume":"147","author":"Mattoo","year":"2021","unstructured":"Mattoo TK, Shaikh N, Nelson CP. Contemporary management of urinary tract infection in children. Pediatrics. 2021;147(2):e2020012138."},{"key":"JPPT-25-00069-b05","series-title":"Pediatrics","first-page":"964","article-title":"The diagnosis and management of acute otitis media","volume":"131","author":"Lieberthal","year":"2013","unstructured":"Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131:964\u2013999."},{"issue":"11","key":"JPPT-25-00069-b06","series-title":"Clin Microbiol Infect","first-page":"793","article-title":"What is antimicrobial stewardship?","volume":"23","author":"Dyar","year":"2017","unstructured":"Dyar OJ, Huttner B, Schouten J, Pulcini C. What is antimicrobial stewardship? Clin Microbiol Infect. 2017;23(11):793\u2013798."},{"issue":"1","key":"JPPT-25-00069-b07","series-title":"Pediatrics","article-title":"Antibiotic stewardship in pediatrics","volume":"147","author":"Gerber","year":"2021","unstructured":"Gerber JS, Jackson MA, Tamma PD, Zaoutis TE. Antibiotic stewardship in pediatrics. Pediatrics. 2021;147(1)."},{"issue":"1","key":"JPPT-25-00069-b08","series-title":"Infect Dis Clin North Am","first-page":"245","article-title":"Antimicrobial stewardship","volume":"25","author":"Tamma","year":"2011","unstructured":"Tamma PD, Cosgrove SE. Antimicrobial stewardship. Infect Dis Clin North Am. 2011;25(1):245\u2013260."},{"issue":"5","key":"JPPT-25-00069-b09","series-title":"Hosp Pediatr","first-page":"438","article-title":"Optimal antibiotics at hospital discharge for children with urinary tract infection","volume":"10","author":"Fusco","year":"2020","unstructured":"Fusco NM, Islam S, Polischuk E. Optimal antibiotics at hospital discharge for children with urinary tract infection. Hosp Pediatr. 2020;10(5):438\u2013442."},{"issue":"10","key":"JPPT-25-00069-b10","series-title":"Open Forum Infect Dis","article-title":"Cefdinir versus cephalexin for the treatment of uncomplicated urinary tract infections","volume":"12","author":"Mitzner","year":"2025","unstructured":"Mitzner TM, Eid KM, Hughson DM, et al. Cefdinir versus cephalexin for the treatment of uncomplicated urinary tract infections. Open Forum Infect Dis. 2025;12(10)."},{"issue":"11","key":"JPPT-25-00069-b11","series-title":"Arch Dis Child","first-page":"899","article-title":"Improved paediatric antimicrobial prescribing with a smartphone application: A before and after interventional study","volume":"108","author":"Primhak","year":"2023","unstructured":"Primhak S, Pool N, Sam MSY, et al. Improved paediatric antimicrobial prescribing with a smartphone application: A before and after interventional study. Arch Dis Child. 2023;108(11):899\u2013903."},{"issue":"6","key":"JPPT-25-00069-b12","series-title":"Am Surg","first-page":"1146","article-title":"Implementation of electronic clinical decision support tools for antibiotic stewardship in pediatric appendicitis","volume":"88","author":"Marulanda","year":"2022","unstructured":"Marulanda K, Willis Z, Wilson W, et al. Implementation of electronic clinical decision support tools for antibiotic stewardship in pediatric appendicitis. Am Surg. 2022;88(6):1146\u20131152."},{"issue":"2","key":"JPPT-25-00069-b13","series-title":"Int J Clin Pharm","first-page":"765","article-title":"The impact of a computerised decision support system on antibiotic usage in an English hospital","volume":"42","author":"Al Bahar","year":"2020","unstructured":"Al Bahar F, Curtis CE, Alhamad H, Marriott JF. The impact of a computerised decision support system on antibiotic usage in an English hospital. Int J Clin Pharm. 2020;42(2):765\u2013771."},{"issue":"4","key":"JPPT-25-00069-b14","series-title":"J Pediatric Infect Dis Soc","first-page":"246","article-title":"Evaluation of a clinical decision support system and an automated electronic health record alert on outpatient prescribing of cefdinir","volume":"13","author":"Courtney","year":"2024","unstructured":"Courtney A, Cook G, Silio M. Evaluation of a clinical decision support system and an automated electronic health record alert on outpatient prescribing of cefdinir. J Pediatric Infect Dis Soc. 2024;13(4):246\u2013249."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/31\/4\/article-p509.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/31\/4\/article-p509.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/31\/4\/article-p509.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:26:20Z","timestamp":1786364780000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/31\/4\/article-p509.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":14,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.5863\/jppt-25-00069","relation":{},"ISSN":["2331-348X","1551-6776"],"issn-type":[{"value":"2331-348X","type":"electronic"},{"value":"1551-6776","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}