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

backgroundInappropriate 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).

methodsWe 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.

resultsAmong 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.