# Patterns of Antibiotic Prescribing for Pediatric Outpatient Visits in the United States: Findings From the National Ambulatory Medical Care Survey 2010-2015

## TL;DR

This study analyzed antibiotic prescriptions for children in US outpatient visits from 2010 to 2015, finding that diagnoses strongly influenced prescribing, with overuse in respiratory conditions.

## Contribution

The study provides updated national data on pediatric outpatient antibiotic prescribing patterns and highlights persistent overuse in non-bacterial conditions.

## Key findings

- Bacterial infections like otitis media and urinary tract infections had the highest antibiotic prescribing probabilities.
- Respiratory illnesses accounted for significant antibiotic use, suggesting ongoing inappropriate prescribing.
- Non-infectious diagnoses rarely received antibiotics, indicating some adherence to guidelines.

## Abstract

Background: Inappropriate antibiotic prescribing for children remains a major public health concern, contributing to antimicrobial resistance (AMR), adverse events, and excess healthcare costs. This study examined prescribing patterns in United States (US) pediatric outpatient visits between 2010 and 2015 using the National Ambulatory Medical Care Survey (NAMCS).

Methods: We conducted a cross-sectional analysis of outpatient encounters for patients aged 0-17 years. Antibiotic prescribing was evaluated by diagnosis category, age group, and patient characteristics. Descriptive statistics and adjusted probabilities were generated. Missing data were assessed, with no imputation applied, as most key variables were complete.

Results: Among 45,666 unweighted pediatric visits, representing 991,561,251 weighted visits, the strongest predictor of antibiotic use was the type of diagnosis. Bacterial infections, particularly otitis media and urinary tract infections, had the highest prescribing probabilities, while non-infectious diagnoses rarely received antibiotics. Respiratory illnesses accounted for substantial prescribing, consistent with prior reports of inappropriate use.

Conclusion: Pediatric antibiotic prescribing during 2010-2015 was primarily diagnosis-driven, with persistent overuse for respiratory conditions. These results underscore the need for strengthened outpatient stewardship strategies to reduce inappropriate use and support guideline-concordant care.