The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2026
Impact of a Formulary Change and Implementation of a Legacy Medication Alternative in the Electronic Medical Record on Antibiotic Prescribing In Children.
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Kemp Hailey, Manasco Kalen B
Аннотация
OBJECTIVE: To assess prescribing patterns following an oral cephalosporin formulary change and the implementation of a legacy medication alternative in the electronic medical record to discourage prescribing cefdinir when de-escalating intravenous ceftriaxone to an enteral antibiotic in pediatric patients.
METHODS: This was a single-center, retrospective cohort study of hospitalized pediatric patients who received at least 1 dose of ceftriaxone de-escalated to an enteral antibiotic for the treatment of community-acquired pneumonia, upper respiratory tract infection, or urinary tract infection. Patients from a 6-month period post-formulary change were compared with a historical cohort from the same timeframe, 1 year prior. The primary outcome was the change in cefdinir prescribing. Secondary outcomes included the rate of optimal antibiotic de-escalation before and after the interventions, hospital length of stay, and hospital re-encounter rates.
RESULTS: A total of 134 patients were included. Cefdinir prescribing occurred in 44% and 34% (p = 0.287) of patients pre- and post-intervention, respectively. Optimal enteral antibiotic de-escalation occurred in 46 (62%) patients pre-intervention and 43 (72%) post-intervention (p = 0.245). Rates of optimal de-escalation were lowest for patients treated for urinary tract infection (< 60% in both cohorts), with cefdinir used in 48% of these cases. Hospital re-encounters occurred in 6 (8%) patients pre-intervention and 0 (0%) post-intervention (p = 0.035). Median length of stay was significantly reduced (p = 0.038) post-intervention, driven by a 1-day reduction in patients treated for community-acquired pneumonia (p = 0.013).
CONCLUSIONS: After the formulary changes involving cefdinir, there was no significant decrease in cefdinir use or in optimal de-escalation rates. There were significantly lower hospital re-encounters and shorter lengths of stay, though further studies are needed to validate these findings.
METHODS: This was a single-center, retrospective cohort study of hospitalized pediatric patients who received at least 1 dose of ceftriaxone de-escalated to an enteral antibiotic for the treatment of community-acquired pneumonia, upper respiratory tract infection, or urinary tract infection. Patients from a 6-month period post-formulary change were compared with a historical cohort from the same timeframe, 1 year prior. The primary outcome was the change in cefdinir prescribing. Secondary outcomes included the rate of optimal antibiotic de-escalation before and after the interventions, hospital length of stay, and hospital re-encounter rates.
RESULTS: A total of 134 patients were included. Cefdinir prescribing occurred in 44% and 34% (p = 0.287) of patients pre- and post-intervention, respectively. Optimal enteral antibiotic de-escalation occurred in 46 (62%) patients pre-intervention and 43 (72%) post-intervention (p = 0.245). Rates of optimal de-escalation were lowest for patients treated for urinary tract infection (< 60% in both cohorts), with cefdinir used in 48% of these cases. Hospital re-encounters occurred in 6 (8%) patients pre-intervention and 0 (0%) post-intervention (p = 0.035). Median length of stay was significantly reduced (p = 0.038) post-intervention, driven by a 1-day reduction in patients treated for community-acquired pneumonia (p = 0.013).
CONCLUSIONS: After the formulary changes involving cefdinir, there was no significant decrease in cefdinir use or in optimal de-escalation rates. There were significantly lower hospital re-encounters and shorter lengths of stay, though further studies are needed to validate these findings.