Theresa Oduol, BS
Theresa Oduol, BS1, Sushama Kattinakere Sreedhara, MBBS, MSPH1, Krista F. Huybrechts, MS, PhD1, Timothy J. Savage, MD, MPH, MSc1,2
Research Category: Allergy, Immunology, Inflammation, and Infectious Diseases
There are more than 5 million pediatric ambulatory diagnoses of skin and soft tissue infections (SSTIs) treated with antibiotics in the United States each year. Recent nation-wide patterns in antibiotic prescribing for purulent SSTIs in children have not been described.
We analyzed the patterns of antibiotic selection and duration for new purulent SSTIs diagnoses among commercially insured pediatric patients (<18 years) between 2015-2020 using the MarketScan Commercial Claims Database. Subjects were included if they had an outpatient encounter with an ICD-10 code for purulent SSTI and a same-day antibiotic prescription dispensation. Patients were excluded if they had an ICD-10 code for purulent SSTI in the preceding 180 days or if they had a same-day diagnosis of another common infection.
A total of 81,171 patients met the inclusion and exclusion criteria. Overall, trimethoprim-sulfamethoxazole represented 45% of all prescriptions, followed by cephalexin (21%), and clindamycin (16%). Sixty-eight percent of prescriptions were for a duration of 10 days, followed by 21% for a duration of 7 days.
In this nationwide cohort of commercially insured children with purulent SSTIs, more than 60% received broad spectrum antibiotics effective against MRSA. Comparative studies of cephalexin against trimethoprim-sulfamethoxazole, and variable treatment durations are indicated.
Skin and soft tissue infections (SSTIs) with pus in children is a common diagnosis resulting in an antibiotic prescription. SSTIs are frequently evaluated in inpatient and outpatient settings and of greater concern is the prevalence of methicillin-resistant S. aureus (MRSA) which commonly causes skin infections with pus. Clinical guidelines from the Infectious Disease Society of America (IDSA) recommend antibiotic therapies effective against MRSA for moderate to severe SSTI infections. However, little is known about adherence rates to these recommendations as nation-wide prescription patterns for this condition have not been described. In this study, we report that most clinicians prescribed the drug, trimethoprim-sulfamethoxazole, and most drugs were prescribed for a duration of 10 days.