1345 - Impact of the COVID-19 Pandemic on Pediatric Ambulatory Antibiotic Use in an Academic Health System

Background: It is unclear how the COVID-19 pandemic has impacted outpatient pediatric antibiotic prescribing.

Methods: We compared diagnoses and antibiotic prescription rates for children pre- vs post-COVID-19 in 5 ambulatory settings affiliated with Vanderbilt University Medical Center: emergency department (ED), urgent care clinics (including pediatric-only after-hours clinics [AHC]s and walk-in clinics [WIC] for all ages), primary care clinics (PCC), and retail health clinics (RHC). Time periods were pre-COVID-19 3/1/19 – 5/15/19 (P1); and post-COVID-19 3/1/20 – 5/15/20 (P2).  Diagnoses and percent of encounters with an antibiotic prescription were analyzed by encounter (in-person vs telemedicine [TMed]), clinic and provider type. We also interviewed 16 providers about perceived COVID-19 impact on pediatric ambulatory antibiotic prescribing.  Student’s T and χ² tests were used as appropriate.  

Results: The number of pediatric ambulatory visits was 16671 in P1 and 7010 in P2. There were no TMed visits in P1 vs 188 in P2 (2.7% of total P2 visits); 186 (99% of TMed visits) were in PCC (Table).  In all settings, the number of encounters was lower in P2 vs P1 (p< 0.001). The percent of encounters with an antibiotic prescription was lower in P2 (32%) than in P1 (38.2%) (p< 0.001) (Table) overall and in all settings except RHCs. Only 14 (7.4%) TMed visits resulted in an antibiotic prescription. There were no differences in antibiotic prescribing rates by provider type. Diagnoses varied significantly between periods in all clinic types except the ED, with noninfectious diagnoses being higher in P2 vs P1 (Figure 1). Providers felt that COVID-19 led to fewer but sicker patients presenting for care, and variable impact on antibiotic prescribing (Figure 2).Table. Percent of Encounters with an Antibiotic by Clinic Type, Pre- and Post-COVID-19
Figure 1. Diagnosis Rates by Clinic Type, Pre- and Post-COVID-19
Figure 2. Themes from Provider Interviews about perceived Impact of COVID-19 on Clinician Practice


Conclusion: The proportion of encounters with non-infectious diagnoses increased and antibiotic prescribing rates decreased significantly in all pediatric ambulatory settings post-COVID-19 except RHCs.  Almost all TMed encounters occurred in the primary care setting, and few resulted in an antibiotic prescription. Providers felt they saw fewer patients and higher acuity of illness post COVID-19.