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Unnecessary antibiotic prescribing in children hospitalised for asthma exacerbation: a retrospective national cohort study
  1. Marcella J Jewell1,
  2. JoAnna Leyenaar2,
  3. Meng-Shiou Shieh1,
  4. Penelope S Pekow1,
  5. Mihaela Stefan1,3,4,
  6. Peter K Lindenauer1,3,4
  1. 1 Institute of Healthcare Delivery and Population Science, Baystate Medical Center, Springfield, Massachusetts, USA
  2. 2 Department of Pediatrics and The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  3. 3 Division of Hospital Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
  4. 4 Department of Population and Quantitative Health Sciences, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA
  1. Correspondence to Ms Marcella J Jewell, Institute of Healthcare Delivery and Population Science, Baystate Medical Center, Springfield, MA 01199, USA; marcella.jewell{at}


Background Antibiotic resistance represents a worldwide public health threat. Characterising prescribing patterns for conditions for which antibiotics have no role can inform antimicrobial stewardship efforts. Asthma is among the most common non-infectious diseases in children and results in 100 000 hospitalisations annually in the USA. We sought to identify the rate of antibiotic prescribing in children hospitalised for asthma exacerbations, and to characterise patient and hospital factors associated with receipt of antibiotics.

Methods Children and adolescents aged 2–17 years admitted to hospital between 1 October 2015 and 30 June 2018 with an asthma exacerbation were identified from the Premier Alliance Database. After excluding hospitalisations for which antibiotics appeared to have been justified, we assessed receipt and duration of antibiotic treatments during the hospital stay. We developed a hierarchical logistic regression model to identify patient and hospital factors associated with antibiotic treatment. For each hospital with at least 10 asthma cases we computed the percentage of cases receiving antibiotic treatment.

Results 23 129 hospital stays met inclusion criteria; in 3329 (14%) of these, antibiotics were prescribed without clear indication. Hospital prescribing rates varied widely (range 0%–95%), with 25% of hospitals prescribing antibiotics at a rate of 27.5% or more. Patient factors most strongly associated with receipt of antibiotics included the presence of a complex chronic condition (OR: 2.4, 95% CI 2.1 to 2.9; p<0.0001) and admission to the intensive care unit compared with a general medical-surgical bed (OR: 1.6, 95% CI 1.5 to 1.9; p<0.0001). Hospitalisation at general hospitals with minimum paediatric specialty support conferred a nearly threefold higher odds of antibiotic treatment (OR: 2.9, 95% CI 1.5 to 5.6; p<0.0001).

Conclusions These findings illustrate an opportunity to reduce unnecessary exposure to antibiotics in children hospitalised with asthma, particularly in general hospitals where three-quarters of children in the USA receive their hospital-based care.

  • paediatrics
  • antibiotic management
  • hospital medicine

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.