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Dermatological Diseases and Infestations · Journal article
Journal of the Pediatric Infectious Diseases Society · September 1, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a single-institution, descriptive analysis of antibiotic prescribing patterns across outpatient clinic types, showing that while specialty clinics (SCCs) prescribe antibiotics less frequently than urgent or primary care, they use broader-spectrum agents for longer durations. The study identifies high-prescribing subspecialties (pulmonology, hematology/oncology, dermatology) but does not assess whether prescribing is inappropriate or associated with clinical outcomes, serving to define a gap for stewardship intervention rather than to evidence a problem or solution.
Descriptive cross-sectional analysis. Pediatric patients with outpatient encounters at urgent care clinics (UCC), primary care clinics (PCC), and pediatric subspecialty care clinics (SCC) at a single institution. Patients evaluated at infectious disease specialty clinics were excluded.. n = 942,617. Single institution (Children's Mercy Kansas City).
Antibiotic prescribing rates were 28.8% in urgent care clinics, 5.4% in primary care clinics, and 1.8% in specialty clinics. Median antibiotic duration in specialty clinics was 10 days versus 7 days in urgent and primary care. Highest prescribing rates in specialty clinics: pulmonology 7.8%, hematology/oncology 5.6%, dermatology 4.3%, adolescent medicine 3.8%, nephrology 3.7%.
Study does not assess whether prescribing was appropriate, guideline-concordant, or associated with clinical outcomes; prescribing rate alone does not indicate over-treatment or harm.
This finding suggests that pediatric specialty clinics may represent an overlooked target for antimicrobial stewardship and warrants prospective assessment of prescribing appropriateness against evidence-based guidelines and clinical outcomes before implementation of interventions. Clinicians in high-prescribing specialties (pulmonology, hematology/oncology, dermatology) should consider whether current practices align with published evidence.
A descriptive analysis of prescribing patterns across clinic types using administrative data, identifying variation and opportunities for intervention but without comparison to guidelines, outcomes, or a control group to establish whether prescribing is inappropriate.
As stated by the source record.
Quoted from the source exactly as published.
This finding suggests that pediatric specialty clinics may represent an overlooked target for antimicrobial stewardship and warrants prospective assessment of prescribing appropriateness against evidence-based guidelines and clinical outcomes before implementation of interventions. Clinicians in high-prescribing specialties (pulmonology, hematology/oncology, dermatology) should consider whether current practices align with published evidence.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Corresponding Author Annie Wirtz, PharmD, BCPPS, Antimicrobial Stewardship Program Director, Children’s Mercy Kansas City, 913-271-1306. alwirtz@cmh.edu Funding No funding to report. Conflicts of Interest All authors, no conflict. Background Over the past decade, outpatient antimicrobial stewardship (ASP) efforts have focused on reducing unnecessary and inappropriate prescribing in primary care clinics (PCCs), urgent care clinics (UCCs), and emergency departments. However, far less attention has been given to prescribing practices in pediatric sub-specialty care clinics (SCCs), despite adult data showing high rates of inappropriate antibiotic prescribing in areas such as dermatology, dentistry, and urology. To address this gap, we sought to evaluate antibiotic prescribing trends across SCCs at our institution to identify opportunities for targeted outpatient ASP interventions. Methods We identified patient encounters for UCC, PCC, and SCC visits between 1/1/2023-12/21/2025. We excluded patients evaluated at Infectious Diseases SCCs. For each setting, we examined the percentage of encounters with antibiotic prescriptions or in clinic administrations. For encounters with antibiotics, we assessed antibiotic class and duration. To examine variability between SCCs, we calculated individual prescribing rates. We used descriptive statistics for all analyses. Results There were 268,896 UCC encounters, 110,953 PCC encounters, and 562,768 SCC encounters. Antibiotics were prescribed more in UCC (28.8%, n=77,562) and PCC (5.4%, n=6,003) compared with SCC (1.8%, n=10,364). Aminoglycosides, fluoroquinolones, macrolides, nitrofurantoin, sulfonamides, and tetracyclines were prescribed more in SCC compared with PCC and UCC (Table 1). The median duration of antibiotics was longer for SCC prescriptions compared to UCC and PCC (10 days vs. 7 and 7 days). SCCs with the highest prescribing rates included pulmonology (7.8%, n=1131), hematology/oncology (5.6%, n=19,646), dermatology (4.3%, n=1,386), adolescent medicine (3.8%, n=306) and nephrology (3.7%, n=591) (Figure 1). Conclusions While antibiotic prescribing occurs less frequently in SCCs compared to other settings, broader-spectrum antibiotics are used more frequently and for longer durations. Because evidence supporting antibiotic use for many subspecialty-specific indications (e.g., inflammatory conditions, urinary tract infection prophylaxis, acne) is limited or controversial, there are opportunities for ASPs to partner with SCCs. Such collaborations can help reduce unnecessary antibiotic exposure and minimize the risk of associated harm.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.