1309. Adherence to Short-Term Antibiotic Therapy in Children – a Blinded, Prospective, Electronically-Monitored Study

Abstract Background Non-adherence to short-term antibiotic treatment in children can lead to treatment failure and development of drug resistance. To develop effective interventional programs reliable adherence data is needed, but previous studies are scarce and have mostly used parental self-reports. We aimed to determine true adherence rates of pediatric patients treated for acute infections with antibiotic suspensions. Secondary goals were to evaluate patient and treatment characteristics influencing adherence rates and whether the prescriber can predict adherence rates of patients. Methods A prospective, blinded, electronically monitored, observational study. Patients aged 2 months to 5 years diagnosed with an acute bacterial infection requiring short (5-10 days) oral antibiotic monotherapy were enrolled. Parents were told they received a new "childproof" cap for evaluation, but unknowingly were provided with an electronically monitored medication bottle recording every manipulation of the cap. At the end of treatment study purpose was disclosed and, if approved, cap data and patient and treatment information collected. Results 100 infants (49 boys, mean [range] age 1.87 years [0.2-5.1]) were included in the final analysis. Only 11 participants received all the recommended doses. Overall adherence (defined as administration of >75% of prescribed doses) was 62%, while timing adherence (administration of >75% of doses within ±20% of the prescribed interval) was only 21%. After applying a logistic regression model, the only factor significantly associated with non-adherence was being a single parent [OR=5.7 95%CI (1.07-30.3)]. Prescribers overestimated adherence, defining 49/62 (77.7%) participants as likely adherent. Patient/parent pairs that were predicted to be adherent were not more likely to be overall or timing adherent than those predicted to be non-adherent (31/47 vs. 6/16, p=0.77). Conclusion Adherence of children to short-term antimicrobial treatment for an acute infection is suboptimal, with only 62% showing good adherence and 21% with good adherence at proper timing intervals. Providers were unable to predict patient adherence. This data is important when considering recommended treatment durations and developing interventional programs to increase adherence. Disclosures All Authors: No reported disclosures.