Oral antibiotic prescribing patterns for treatment of pulmonary exacerbations in two large pediatric CF centers

Pediatr Pulmonol. 2020 Sep 24. doi: 10.1002/ppul.25092. Online ahead of print.


INTRODUCTION: Oral antibiotics are frequently prescribed for outpatient pulmonary exacerbations (PEx) in children with cystic fibrosis (CF). This study aimed to characterize oral antibiotic use for PEx and treatment outcomes at two large U.S. CF centers.

METHODS: Retrospective, descriptive study of oral antibiotic prescribing practices among children with CF ages 6- 17 years over one year. The care setting for antibiotic initiation(clinic or phone encounter) was determined and outcomes were compared.

RESULTS: 763 oral antibiotic courses were prescribed to 312 patients ages 6-17 years (77% of 403 eligible patients) with a median of 2 courses per year (range 1-10). Fifty-eight percent of prescriptions were provided over the phone. Penicillin was the most commonly prescribed antibiotic class (36% of prescriptions) but differences in antibiotic class prescriptions were noted between the two centers. Hospitalizations occurred within 3 months following 19% of oral antibiotic courses. FEV1 recovered to within 90% of prior baseline within 6 months in 87% of encounters; the mean (SD) % recovery was 99.6% (12.1%) of baseline. Outcomes did not differ between phone and clinic prescriptions.

CONCLUSIONS: Phone prescriptions, commonly excluded in studies of PEx, made up more than half of all oral antibiotic courses. Heterogeneity in prescribing patterns was observed between the two centers. Most patients had improvement in FEV1 returning to near their prior baseline, but hospitalizations occurred in one-fifth following oral antibiotic treatment. Efforts to optimize PEx treatment must consider care that occurs over the phone; this is particularly important as the use of telemedicine increases. This article is protected by copyright. All rights reserved.

PMID:32970375 | DOI:10.1002/ppul.25092