In a new study of children 6 to 18 months of age, researchers found the odds of receiving first-line antibiotic therapy in pediatric urgent care centers (PUCs) were lower among White children and those with commercial insurance than in other groups. Authors of the study presented in Infection Control & Hospital Epidemiology looked at guideline-recommended first-line antibiotics for acute respiratory infections (ARIs) for 396,340 encounters at 28 PUCs in the United States over 1 year. ARIs included viral respiratory infections, otitis media with effusion, acute otitis media, pharyngitis, community-acquired pneumonia, and sinusitis, and data showed that overall 88.8% of kids received first-line therapy. The odds of receiving first-line therapy were higher in children with Medicaid or Medicare coverage (adjusted odds ratio [aOR] 1.21; 95% confidence interval [CI], 1.18 to 1.24) and those who self-pay (aOR 1.18; 95% CI, 1.1 to 1.27) than in commercially insured children. Adjusted odds of receiving first-line therapy were higher in Black (aOR 1.53; 95% CI, 1.47 to 1.59), Asian (aOR 1.46; 95% CI, 1.40 to 1.53), and Hispanic children (aOR 1.37; 95% CI, 1.33 to 1.41) than in White children.
Overarching trend: The study is somewhat surprising in that data shows White, commercially insured kids are less likely to get first-line antibiotics, although the reason is not clear. Certainly, health disparities are front and center in the industry at large with many states creating strategic initiatives to study and solve for ethnic and racial disparities while also addressing care needs driven by social determinants of health. The challenge is to methodically identify disparities and then to design and fund appropriate programs for improvement.