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Oral antibiotic prescribing patterns for treatment of pulmonary exacerbations in two large pediatric CF centers
Journal article   Peer reviewed

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

Jordana E Hoppe, Daniel M Hinds, Adrianne Colborg, Brandie D Wagner, Wayne J Morgan, Margaret Rosenfeld, Edith T Zemanick and Don B Sanders
Pediatric pulmonology, Vol.55(12), pp.3400-3406
12/2020
DOI: 10.1002/ppul.25092
PMID: 32970375

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Abstract

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 US CF centers. Retrospective, descriptive study of oral antibiotic prescribing practices among children with CF ages 6-17 years over 1 year. The care setting for antibiotic initiation (clinic or phone encounter) was determined and outcomes were compared. A total of 763 oral antibiotic courses were prescribed to 312 patients aged 6-17 years (77% of 403 eligible patients) with a median of two 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. Forced expiratory volume in 1 s (FEV ) 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. 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 FEV 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.
 Administration, Oral Adolescent Anti-Bacterial Agents - therapeutic use Bacterial Infections - drug therapy Child Cystic Fibrosis - drug therapy Cystic Fibrosis - physiopathology Drug Prescriptions - statistics & numerical data Female Forced Expiratory Volume Humans Lung - drug effects Lung - physiopathology Male Retrospective Studies Treatment Outcome

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