Differences in antibiotic prescribing patterns for children younger than five years in the three major outpatient settings

Objectives To perform a comprehensive analysis of the use of antibiotics in three major sites for outpatient care: private office-based clinics, emergency departments (ED), and hospital-based clinics. Study design Data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to determine visit rates and antibiotic prescribing patterns for the three major outpatient care settings from 1994 to 2000 for children <5 years of age. Results Antibiotic prescription rates declined from 1400 to 1076 per 1000 children over the study years (P = .034). Significant declines in antibiotic prescriptions were noted in both the office-based setting and ED: 1114 to 832 (P = .053) in the office-based setting and 236 to 194 antibiotic prescriptions per 1000 children in the ED (P = .005). Sites of care differed markedly with white children receiving 82.5%, 14.3%, and 3.2% of antibiotics in the office-based settings, ED, and hospital-based clinics, respectively, compared with 60%, 31%, and 9% for black children (P < .001). However, total visits, visits resulting in a diagnosis of otitis media, and antibiotic prescribing rates were similar for white and black children during the latter study years. Conclusions There has been a decline in antibiotic prescribing in children <5 years of age, which was most notable in office-based and emergency department settings.