Antibiotics Overprescribed for Pediatric Pharyngitis

A research letter published in JAMA Pediatrics uncovered a gap between observed practice and guideline recommendations in medication prescribing for pediatric pharyngitis.

A multifaceted team of researchers examined data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, which are 2 nationally representative samples of ambulatory care practices. They included data from pharyngitis patients aged 3 to 17 years between January 1, 1997, and December 31, 2010.

Of those subjects, 462 had acute pharyngitis, 463 had acute tonsillitis, and 34 had streptococcal sore throat and scarlet fever. Ambulance patients were excluded if they had concomitant infection that warranted other antibiotic therapy.

Between 1997 and 2010, there were approximately 12 million pediatric visits for pharyngitis, or about 198 related visits per 1000 children. During more than half of the visits (60%), antibiotics were prescribed, and 61% of those prescriptions were for narrow-spectrum penicillin. However, such prescribing decreased from 65% of antibiotics in 1997 to 1998, to 52% in 2009 to 2010, while prescriptions for broader-spectrum antibiotics increased.

Macrolides and first-generation cephalosporins—which are second-line antibiotics for group A Streptococcus (GAS) pharyngitis—accounted for 21% of antibiotics prescribed, while second- and third- generation cephalosporins and amoxicillin-clavulanate, which are not recommended, comprised 18%.

“Despite the release of multiple clinical guidelines recommending narrow-spectrum penicillins for first-line treatment of GAS pharyngitis, their use did not increase,” the authors concluded. “…Similar to previous findings in adults and children, narrow-spectrum penicillins are underprescribed in favor of broader-spectrum antibiotics, especially macrolides and cephalosporins.”

The researchers noted their study was limited by the unknown amount of GAS testing and prevalence of penicillin, and continued follow-up is necessary to verify the apparent negative trend in penicillin prescribing.