Ambulatory visit rates and antibiotic prescribing for XXXX with pneumonia, 1994-2007.

@entity1 @entity497 @entity5898 @entity2886
BACKGROUND: The incidence of pediatric hospitalizations for @entity497 ( @entity497 ) has declined after the widespread use of the heptavalent pneumococcal conjugate vaccine. The national incidence of outpatient visits for @entity497 , however, is not well established. Although no pediatric @entity497 treatment guidelines are available, current data support narrow-spectrum antibiotics as the first-line treatment for most @entity1 with @entity497 . OBJECTIVE: To estimate the incidence rates of outpatient @entity497 , examine time trends in antibiotics prescribed for @entity497 , and determine factors associated with broad-spectrum antibiotic prescribing for @entity497 . @entity1 AND METHODS: The National Ambulatory and National Hospital Ambulatory Medical Care Surveys (1994-2007) were used to identify @entity1 aged 1 to 18 years with @entity497 using a validated algorithm. We determined age group-specific rates of outpatient @entity497 and examined trends in antibiotic prescribing for @entity497 . Data from 2006-2007 were used to study factors associated with broad-spectrum antibiotic prescribing. RESULTS: Overall, annual @entity497 visit rates ranged from 16.9 to 22.4 per 1000 population, with the highest rates occurring in @entity1 aged 1 to 5 years (range: 32.3-49.6 per 1000). Ambulatory @entity497 visit rates did not change between 1994 and 2007. Antibiotics commonly prescribed for @entity497 included macrolides (34% of @entity1 overall), @entity2886 (22% overall), and penicillins (14% overall). @entity5898 use increased significantly between 2000 and 2007 (P = .002). Increasing age, a visit to a nonemergency department office, and obtaining a radiograph or complete blood count were associated with broad-spectrum antibiotic prescribing. CONCLUSIONS: The incidence of @entity497 has not changed significantly between 1994 and 2007, despite the introduction of heptavalent pneumococcal conjugate vaccine in 2000. Broad-spectrum antibiotics, particularly macrolides, were frequently prescribed despite evidence that they provide little benefit over penicillins.
