Antibiotic prescribing habits of nurse practitioners treating pediatric patients: AntiBUGS pediatrics.

Antibiotics are among the most frequently prescribed drugs—both by nurse practitioners (NPs) and by other prescribers. In June 2006, the American Academy of Nurse Practitioners (AANP) Foundation, working with AANP, conducted two versions of the Antibiotic Use and Guidelines Survey (AntiBUGS), designed to contribute to better understanding NP antibiotic decision making and prescribing. While the content of the two surveys was similar, one addressed prescribing for adult patients (AntiBUGS adult) and the other addressed prescribing for infants and/or children (AntiBUGS pediatrics). With the exception of the target sample for each survey, the methodology was the same. This report describes the findings from AntiBUGS pediatric survey. The results from the companion adult survey have been reported earlier (Goolsby, 2007). The survey was fielded through an electronic invitation e-mailed to 2500 AANP members who, based on their previously self-identified ‘‘main’’ specialty, were likely to treat infants and children. The e-mail included instructions and a link to an online survey. The goal was to collect data from 500 participants (20% response) within a 2-week period. Because it was impossible to know whether, in fact, the e-mails had reached anticipated recipients and which of the surveyed NPs actually prescribed antibiotics for pediatric patients, an additional 400 invitations were e-mailed several days before the close of the survey. A total of 479 responses were received. The participating NPs had a mean of 7.8 (range <1–35) years of NP experience. Respondents identified their clinical specialty as follows: pediatric (14.1%), family (75.8%), emergency (6.9%), and other (3.2%). Over 96% of respondents indicated that they routinely considered the classification of antibiotics and differences between the classes when prescribing antibiotics. Three percent indicated that they considered classification only sometimes. Participants were asked to identify the top three antibiotics they prescribed for each of the following conditions: acute otitis media (OM), acute sinusitis, and pharyngitis/ tonsillitis. They were given a list of antibiotics from which to choose and three spaces in which they could type in other antibiotics if their top choices were not listed. In each instance, participants were to select only three. For OM, almost all (91.6%) selected amoxicillin as one of their top three choices, followed by amoxicillin/ clavulanate (81.6%). Only 9.4% wrote in agents not listed as choices, with trimethoprim–sulfamethoxazole being the most frequent selection (Table 1). Questioned further about treatment of OM, the majority of NPs indicated that they always (3.4%) or very often (51.6%) implemented watchful waiting instead of prescribing an antibiotic as the first strategy for treating acute OM. According to those who did not implement watchful waiting often, several were concerned about risk of complications/worsening (16%) and that parents were not accepting of ‘‘watchful waiting’’ (13%). Six percent identified difficulty in scheduling follow-up appointments as a reason to prescribe as a first strategy. Factors selected as most likely to make ‘‘watchful waiting’’ work included providing parents with adequate information (51.9%), establishing a follow-up plan to monitor response/ progression (35%), and use of effective symptom management interventions (13%). For acute sinusitis, the top agents identified by the respondentswereamoxicillin/clavulanate (84.3%) followed byamoxicillin (59.9%)andazithromycin (56.6%). Approximately 24% of respondents wrote in one or more antibiotics for sinusitis, with clarithromcycin most frequently added (Table 2). Over 80% selected amoxicillin as one of their top choices for treatingpharyngitisand/or tonsillitis (seeTable 3). Almost 15% added a penicillin drug as their top choice for pharyngitis in pediatric patients. A related item asked respondents to identify their preferences for treating sore throats with a positive streptococcal test or culture and their preference for treating recurrent streptococcal