Antibiotic Duration in CAP and AOM
Here is a study out of Canada that looked at adherence to the guidelines for outpatient antibiotic prescriptions in pediatric patients with either acute otitis media or community-acquired pneumonia.
Background: recent evidence-based guidelines have been recommending shorter and shorter durations for prescriptions for these very common infections. In Canada, the recent recommendations have encouraged 5 day courses of amoxicillin as first line in AOM (patients >2 years old) and all CAP patients (for everyone seemed to be stable for outpatient management).
What did they do/find: researchers reviewed the charts of patients aged 0-18 discharged from the ED with a diagnosis of either AOM or CAP from 9/22-9/23. There were 1143 cases of AOM and 753 cases of CAP that met inclusion criteria. Only 60% of AOM prescriptions and 19% of CAP prescriptions followed the new guidelines. The most common reasons for fallout were 1) duration 2) dosing interval 3) antibiotic selection and 4) dose.
*for funsies, a 2024 study out of Nashville showed similar results for over 500,000 antibiotic prescriptions (included a broader spectrum of infections)- about 50% were of optimal duration and 38% were the right antibiotic choice.
**these are the Canadian and international recommendations; AAP/IDSA recommendations for AOM are 10 days of amox if <2 years old or older patients with severe symptoms, 7 days if 2-5 years old, and 5 days for patients 6 and over; for CAP the general recommendation is 5 days of amoxicillin (with recent studies even suggesting 3 days could be sufficient)**
Bottom Line: make sure you are following the most up-to-date guidelines for antibiotic prescriptions for these more common infectious conditions that can often be treated as an outpatient. Antibiotic overuse leads to increasing resistance patterns and increasing adverse events.
Background: recent evidence-based guidelines have been recommending shorter and shorter durations for prescriptions for these very common infections. In Canada, the recent recommendations have encouraged 5 day courses of amoxicillin as first line in AOM (patients >2 years old) and all CAP patients (for everyone seemed to be stable for outpatient management).
What did they do/find: researchers reviewed the charts of patients aged 0-18 discharged from the ED with a diagnosis of either AOM or CAP from 9/22-9/23. There were 1143 cases of AOM and 753 cases of CAP that met inclusion criteria. Only 60% of AOM prescriptions and 19% of CAP prescriptions followed the new guidelines. The most common reasons for fallout were 1) duration 2) dosing interval 3) antibiotic selection and 4) dose.
*for funsies, a 2024 study out of Nashville showed similar results for over 500,000 antibiotic prescriptions (included a broader spectrum of infections)- about 50% were of optimal duration and 38% were the right antibiotic choice.
**these are the Canadian and international recommendations; AAP/IDSA recommendations for AOM are 10 days of amox if <2 years old or older patients with severe symptoms, 7 days if 2-5 years old, and 5 days for patients 6 and over; for CAP the general recommendation is 5 days of amoxicillin (with recent studies even suggesting 3 days could be sufficient)**
Bottom Line: make sure you are following the most up-to-date guidelines for antibiotic prescriptions for these more common infectious conditions that can often be treated as an outpatient. Antibiotic overuse leads to increasing resistance patterns and increasing adverse events.
