Empiric treatment of sexually transmitted infections in a pediatric Emergency Department: are we making the right decisions?

ABSTRACT

OBJECTIVE: Limited recommendations address empiric versus delayed treatment of pediatric patients for sexually transmitted infections (STIs). This study investigates how frequently empiric STI treatment correlated with subsequent positive test results in an urban, high-risk pediatric emergency department (PED). METHODS: A retrospective chart review was performed on patients 18 years and younger who presented to an urban PED and had testing for Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT). RESULTS: The positivity rate for STI among the 198 patients who met inclusion criteria was 28%. In 130 patients (66%), providers' management decision regarding use of empiric antibiotics correlated with subsequent test results. 45 patients (23%) received unnecessary antibiotics. Of the 23 patients (12%) who were positive for STI, but did not receive treatment, 43% (10) had difficulties with followup. CONCLUSIONS: Providers in high-risk pediatric populations with unreliable patient follow-up should consider having a low threshold for empiric treatment. Development of clinical decision rules and/or strategies to improve patient follow-up may help optimize empiric STI treatment decisions in the PED.