Assessment of Ambulatory Antibiotic Prescribing Trends for Urinary Tract Infections in Infants and Children

The United States Centers for Disease Control and Prevention (CDC) estimates that the infections caused by antibiotic-resistant bacteria result in about 2 million cases of illness and 23,000 deaths in the U.S. annually.1 The European Centre for Disease Prevention and Control produces similar numbers, estimating that antibiotic-resistant bacteria kill approximately 33,000 Europeans every year.2 Prevalence of urinary tract infections (UTI) in the US is about 7 percent in patients aged infants and children 2 to 24 months.3 It is estimated that Pediatric urinary tract infection (UTI) costs the healthcare system upwards of 180 million dollars annually, and accounts for over 1.5 million clinician visits per year.4 UTIs account for 1.8% of all pediatric hospitalizations. In the beginning of the last decade, the hospital costs for UTIs were $2,585 per hospitalization and rose to $3,838 by 2006. UTIs account for mean hospital charge increase from $6,279 to $10,489 per admission. That same pharmacoeconomic analysis study reports that aggregate hospital charges associated with UTIs exceeded $520 million in the last decade.5 As we can see, UTIs present not only an increased in healthcare costs directly and decreased quality of life for the children, but also in indirect costs, such as lost wages resulting from parents missing work due to need for caring for the sick child. Identifying antibiotic prescribing patterns for pediatric UTIs is important in terms of recognizing whether there is antibiotic overuse or misuse, increased mediation costs and, most importantly, increased antibiotic resistance. Urinary tract is the most common site of occult and serious bacterial infections. Most of the time there is no identified source of infection.6 Studies support that delays in appropriate treatment of pyelonephritis increase the risk of renal damage. The epidemiology of urinary tract infections (UTIs) in children often varies by age, gender and other factors. 7 About 8% of girls and 2% of boys experience at least one UTI before the age of 7. UTI may lead to transient renal failure in 40% and permanent renal damage in 5% of patients. 8 The incidence of UTIs is the highest in the first year of life for all children but will often decrease among boys after infancy. 7 Rising health care costs, over utilization of health care resources, medication errors and inappropriate prescribing are challenging issues facing the health care researchers. According to Center for Disease Control and Prevention (CDC), antibiotic resistance has risen in the last decade. Current antibiotics in the market are losing their effects at an alarming rate, while the development of new agents isn’t keeping pace with it. Despite the “National Action Plan for Combating Antibiotic-Resistant Bacteria” goal of reducing inappropriate outpatient antibiotic use by 50% by 2020, but the extent of in appropriate prescribing remains large.9 When combing diagnosis and ages, 30% of the prescriptions prescribed from 2010 to 2011 in ambulatory care settings throughout the US were inappropriate.