Antibiotic prescribing practices for acute otitis media and community-acquired pneumonia in a pediatric emergency department
Bibliographic record
Abstract
Background: Recent evidence-based pediatric guidelines recommend a 5-day course of amoxicillin as first-line therapy for uncomplicated acute otitis media (AOM) in children 2 years and older and community-acquired pneumonia (CAP). The objective of this study was to assess the guideline consistency of antibiotic prescriptions for AOM and CAP in a Canadian quaternary care pediatric emergency department (ED) and identify opportunities to improve antibiotic prescribing. Methods: We retrospectively reviewed antibiotic prescriptions for patients 0 to 18 years old discharged from the ED with a diagnosis of AOM or CAP from September 2022 through September 2023. Clinical information and prescription data were extracted from the electronic medical record. Analysis was completed using descriptive statistics. Results: Of 2313 retrieved records, 1143 (85%) cases of AOM and 753 (75%) cases of CAP met the inclusion criteria. Six hundred and eighty-eight (60%) AOM prescriptions and 140 (19%) CAP prescriptions were guideline-consistent. Prescriptions were not guideline-consistent largely because of antibiotic duration (62% for AOM-67% attributable to excess duration; 93% for CAP- > 99% attributable to excess duration), followed by antibiotic dosing interval (31% for AOM; 22% for CAP), antibiotic selection (17% for AOM; 6% for CAP) and antibiotic dose (8% for AOM; 2% for CAP). Of 293 patients eligible for deferred prescriptions for AOM based on age and clinical presentation, only 52% received them. Conclusions: Most guideline-discordant prescriptions for both AOM and CAP resulted from prolonged antibiotic duration. Given the frequency of these diagnoses, effective interventions to improve guideline consistency would have a significant impact at a population level.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".