# The Invisible Excess: Too Long Antibiotic Duration in the Pediatric Emergency Care

## TL;DR

This study finds that antibiotics are often prescribed for longer than needed in pediatric emergency care, especially for pneumonia.

## Contribution

The study identifies uncomplicated community-acquired pneumonia as the leading cause of excessive antibiotic duration in pediatric emergency settings.

## Key findings

- 28.3% of antibiotic prescriptions in the PED were inappropriate due to longer-than-recommended duration.
- Uncomplicated CAP accounted for 76.2% of inappropriate antibiotic prescriptions.
- Amoxicillin was the most frequently overprescribed antibiotic.

## Abstract

Background/Objectives: Antibiotics are among the most commonly prescribed medicines in the Pediatric Emergency Department (PED). The overuse of antibiotics is directly linked to the emergence of resistance. Recent clinical trials have emerged in children in which short courses have proven to be as effective as longer courses. The aim of this study was to analyze the duration of antibiotic treatment prescribed in our PED for the most important and common infections in children and to compare with the best available evidence. Methods: A single-center retrospective study was conducted in the PED of a tertiary hospital. We evaluated outpatients from birth to 16 years who were discharged with antibiotic therapy during a 1-year period (2022) to classify duration of therapy as appropriate or inappropriate. Results: 1972 antibiotic prescriptions were analyzed. 28.3% (560/1972) of the prescriptions were classified as inappropriate according to duration of therapy; 551 (98.3%) were due to longer-than-recommended duration. The condition associated with the highest number of inappropriate prescriptions was Uncomplicated Community-acquired Pneumonia (CAP) (427/560; 76.2%). When focusing on each infectious syndrome, Uncomplicated CAP had also the highest percentage of inappropriate duration (92.6%) comparing with appropriate prescription. Regarding specific types of antibiotics, amoxicillin accounted for the highest number of inappropriate prescriptions (422/560; 75.4%). Conclusions: A longer-than-recommended prescription of antibiotics is frequent in the Pediatric Emergency Department. Uncomplicated CAP is the condition associated with the highest number of inappropriate duration of antibiotics in our setting.