Urgent Care Centers: Antibiotic Prescribing Patterns for Pediatric Respiratory Tract Infections

Background: Antibiotic resistance is a significant health threat worldwide and contributes to increased hospitalization and mortality. Since 30% of antibiotics are unnecessary and the majority of pediatric prescriptions occur in the outpatient setting, this is an ideal focus for antibiotic stewardship efforts. Variation between antibiotic prescribing occurs depending on the setting in which care is received (emergency department, primary care office vs. urgent/retail center), and a growing portion of prescriptions are originating from urgent care centers. We sought to evaluate antibiotic prescribing patterns for pediatric upper respiratory tract infections for care received in urgent care settings.

Methods: Urgent care records available within our electronic medical record for our pediatric patients were reviewed. Data were collected for urgent and retail care visits that occurred between November 2019 and December 2020. Records were included in the analysis if they were for a pediatric patient through age 19 and resulted in an upper respiratory tract infection diagnosis (such as sinusitis, acute otitis media, pharyngitis, upper respiratory tract infection). Data collected for care received from 26 different urgent and retail health care centers were analyzed in SAS 9.4.

Results: There were 303 urgent care records available for review and of these cases 143 children (47%) had antibiotics prescribed. The mean age for antibiotic use was 6.2 years while the mean age for no antibiotic prescribed was 8.9 years (p < 0.0001). Children who were under 5 years old were 2.08 times more likely (95%CI 1.29, 3.35) to receive an antibiotic than children over 5 years of age. Children were diagnosed with pharyngitis (n=22, 7.3%), Otitis media (n=78, 25.7%), Pneumonia (n=5, 1.7%), URI (n=63, 20.8%), Strep throat (n=24, 7.9%), Viral pharyngitis (n= 7, 2.3%), Sinusitis (n=9, 3%) and 134 had another diagnosis (such as influenza, otitis externa, bronchitis). Sinusitis was treated with antibiotics in 100% of cases. Of these, only 1 patient had a fever, 2 (22.2%) had symptoms for 1 day, and 3 (33.3%) had symptoms for 10 days. URI was treated with an antibiotic 8 times (12.9 %). Teaspoons were used in 67 (21.9%) prescriptions. After controlling for age, insurance type (private/public), and race (white/other), having a fever was associated with an increased risk of having an antibiotic prescribed (OR=2.79 (95%CI 1.44, 5.40)).

Conclusion: In this analysis of pediatric urgent care for upper respiratory tract infections, we found that younger age and presence of a fever were associated with an increased risk of having an antibiotic prescribed. Additionally, the use of teaspoons is common in this setting although it is discouraged. Further research is needed to better understand the antibiotic prescribing patterns and disseminate education interventions to promote guideline concordant antibiotic prescribing.