Pediatric Infectious Diseases

Antimicrobial Stewardship

Guideline-Consistent Antibiotic Selection by Diagnosis

2018-2020

The Centers for Disease Control and Prevention (CDC) estimates that out of nearly 154 million outpatient antibiotic prescriptions issued each year, approximately 30% are unnecessary. To that end, the Cleveland Clinic Antimicrobial Stewardship committee, in collaboration with the Office of Clinical Compliance, has begun tracking the appropriateness of prescriptions for 4 common diagnoses: otitis media, pharyngitis, sinusitis, and urinary tract infection. The committee evaluates whether diagnostic codes and prescriptions were consistent with clinical practice guidelines, and whether prescriptions were consistent with patient allergy to penicillin, if applicable. The committee does not consider micro-biologic data, additional antibiotic allergies, previous treatment failures, or other patient-specific factors.

CDC. (2016). CDC: 1 in 3 antibiotic prescriptions unnecessary. https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html

Otitis MediaPharyngitisSinusitisUrinary Tract Infection (UTI)Upper Respiratory Tract Infection (URTI)
2018 Cleveland Clinic Children's

86%

(8154/9516)

79%

(3908/4926)

87%

(2499/2878)

85%

(328/388)

no data available
2019 Cleveland Clinic Children's

85%

(6491/7640)

83%

(2509/3014)

87%

(2119/2424)

84%

(173/206)

90%

(13987/15521)

2020 Cleveland Clinic Children's

86%

(2397/2789)

86%

(1123/1313)

89%

(748/840)

54%

(85/155)

92%

(6995/7575)

National Estimate¹67%60%50%N/AN/A

¹Hersh AL, Fleming-Dutra KE, Shapiro DJ, Hyun DY, Hicks LA; for the Outpatient Antibiotic Use Target-Setting Workgroup. Frequency of first-line antibiotic selection among US ambulatory care visits for otitis media, sinusitis, and pharyngitis. _JAMA Intern Med. _2016;176(12):1870–1872

ᵃNo national estimate available.

ᵇDefinition change eliminated 3rd generation cephalosporin as guideline concordant (88% old-definition)