(P-105) Comparison of Pediatric Antibiotherapy in Primary Care: Low vs. High Prescribers

Background: Physicians prescribe antibiotics for children more often than that for other age groups. Apart from clinical suitability, many factors influence antibiotic prescribing behavior, including the burden of outpatient visits on the physicians.

Objectives: We aimed to compare antibiotic prescribing for children by low prescribers (LP) and high prescribers (HP) in primary care.

Methods: We retrospectively analyzed all prescriptions generated for children by primary care physicians who were randomly selected by systematic sampling (n=1431) in Istanbul in 2016. Among the physicians who generated ≥1 pediatric prescription/day (n=1218) in the study period, those in the lowest (n=305) and highest (n=304) quartile of prescribing were defined as LP and HP. The antibiotic prescribing characteristics of these groups were compared.

Results: We identified that 38.5% of the prescriptions written by physicians included antibiotics, significantly higher in HPs (38.8%) than in LPs (37.2%), (p=0.04). Among antibiotic-containing prescriptions, the number of drug and box per prescription, the percentage of prescriptions containing injectable drugs and antibiotics were significantly higher in HPs compared to that in LPs (p < 0.05 for all pairwise comparisons). We detected that co-amoxiclav was the most frequently prescribed antibiotic in the LP and HP groups (61.1% and 48.3%, respectively). Stratification of antibiotics by their spectra showed that 11.2% were narrow, 79.8% were broad and 0.5% were ultra-broad-spectrum drugs. LPs were found to be significantly more likely to prescribe broad-spectrum antibiotics (82.5%) than do HPs (78.9%, p<0.001). J06-unspecified acute respiratory tract infection was the most common indication for both narrow- and broad-spectrum antibiotics (16.4% and 17.5%, respectively).

Conclusions: It has been shown that near 40% of pediatric prescriptions contain antibiotics, slightly more marked in HPs. While HPs also tend to prescribe higher number of overall and injectable drugs and antibiotics, broad-spectrum antibiotherapy seems to be more practiced by LPs.