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Providers often prescribe antibiotics during asthma-related ambulatory care visits

DENVER — Sixteen percent of asthma-related office and emergency department visits from 1998 to 2007 resulted in the prescription of an antibiotic, despite the fact that these visits did not have an ICD-9 code that would justify the use of an antibiotic, according to research presented at the Pediatrics Academic Societies' Annual Meeting 2011, held here.

According to Ian M. Paul, MD, associate professor of pediatrics and public health at Penn State University, some health care providers prescribe antibiotics to patients with asthma exacerbations because some research has shown that macrolide antibiotics have anti-inflammatory properties that could help in treating asthma.

“For asthma-related ambulatory care visits, one out of seven of the patients received a prescription for an antibiotic when the need for an antibiotic is not documented,” Paul said. “Use of evidence-based guidelines and/or decision trees may result in judicious use of antibiotics when treating children with asthma exacerbations.”

An estimated 60.4 million visits were coded for asthma, and during 16% of these visits, an antibiotic was prescribed without an ICD-9 code to justify the antibiotic use. Macrolides were the most common antibiotic prescribed (48.8%).

Multivariate analysis results indicated that the likelihood of antibiotic use increased during the winter season (OR=1.89; 95% CI, 1.03-3.47) and with the prescription of an oral corticosteroid (OR=2.69; 95% CI, 1.69-4.29).

Treatment in an emergency department decreased the likelihood of antibiotic use (OR=1.17; 95% CI, 0.34-3.98).

Paul and colleagues studied the frequency of antibiotic use by examining data from the 1998-2007 National Ambulatory Medical Care Surveys and the National Hospital Ambulatory Medical Care Survey. These data showed the number of office visits and emergency department visits made by children due to asthma exacerbation and the frequency of antibiotic use. They used ICD-9 codes to determine whether the antibiotic use was justified.

Disclosures: Dr. Paul reported no disclosures.

For more information:

• Paul IM. #1365.4. Frequency of antibiotic use for pediatric ambulatory care visits for asthma. Presented at: Pediatric Academic Societies’ Annual Meeting 2011. April 30-May 3, 2011. Denver.

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