Recent Trends in Outpatient Antibiotic Use in Children

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Antibiotic use for children has decreased dramatically over the last 20 years. Programs encouraging judicious antibiotic use have focused both on decreasing overall antibiotic use and appropriate prescribing of broad-spectrum agents. WHAT THIS STUDY ADDS:Large declines in antibiotic rates were prominent in the early 2000s. This trend has attenuated, and use has leveled off in some age groups and locales; continued improvement in the use of broad-spectrum agents is possible.abstract OBJECTIVE: The goal of this study was to determine changes in antibiotic-dispensing rates among children in 3 health plans located in New England [A], the Mountain West [B], and the Midwest [C] regions of the United States. METHODS: Pharmacy and outpatient claims from September 2000 toAugust 2010 were used to calculate rates of antibiotic dispensing per person-year for children aged 3 months to 18 years. Differences in rates by year, diagnosis, and health plan were tested by using Poisson regression. The data were analyzed to determine whether there was a change in the rate of decline over time.RESULTS: Antibiotic use in the 3-to ,24-month age group varied at baseline according to health plan (A: 2.27, B: 1.40, C: 2.23 antibiotics per person-year; P , .001). The downward trend in antibiotic dispensing slowed, stabilized, or reversed during this 10-year period. In the 3-to ,24-month age group, we observed 5.0%, 9.3%, and 7.2% annual declines early in the decade in the 3 plans, respectively. These dropped to 2.4%, 2.1%, and 0.5% annual declines by the end of the decade. Third-generation cephalosporin use for otitis media increased 1.6-, 15-, and 5.5-fold in plans A, B, and C in young children. Similar attenuation of decline in antibiotic use and increases in use of broadspectrum agents were seen in other age groups.CONCLUSIONS: Antibiotic dispensing for children may have reached a new plateau. Along with identifying best practices in low-prescribing areas, decreasing broad-spectrum use for particular conditions should be a continuing focus of intervention efforts. 22 For children aged ,5 years, in whom antibiotic utilization is highest, an impressive 36% reduction in the use of antibiotics for RTIs occurred between 1995 and 2006. 23 It is unknown whether the previous downward trend in antibiotic use will continue or if a leveling off of prescribing will soon be reached. Stabilization of antibiotic use rates may be appropriate if principles of judicious use are being followed or it may signal the need for new interventions. A recent study from a limited number of communities in Massachusetts indicated that stabilization of dispensing has occurred in children aged ,6 years. 24 Because geographic variation exists in antibiotic prescribing, 21,25-27 we investigated trends in community antibiotic dispensing in children aged ,18 years insured by 3 geographically distinct health plans to examine whether rates have leveled off at these sites. We also explored trends in antibiotic utilization for common infect...

Reducing Unnecessary Antibiotics Prescribed to Children: What Next?

“…While the medical community should be proud of this success, the article by Vaz et al 4 in this issue of Pediatrics provides an important cautionary note, Consistent with other work, 5 the authors found that the trend of decreasing antibiotic prescribing has stalled in 3 health systems. They also identified persistent and rampant overuse of broad-spectrum antibiotics.…”

“…Vaz et al 4 found that ∼1 in 10 antibiotics were not associated with a visit. Anecdotally, we hear of physicians who commonly prescribe antibiotics to a child on the basis of history only.…”

Use of Bionexia Strep A Plus Rapid Antigen Test in the Identification of Group A Beta-Hemolytic Streptococci in Throat Swab Samples

“…Sürecin uzaması tedavide gecikmeye ya da gereksiz antibiyotik kullanımına neden olabilmektedir. Amerika'da tedavileri ayaktan düzenlenen solunum yolu enfeksiyonlu 12 yaş altı hastaların %75'inde antibiyotik kullanıldığı ve bu hastaların büyük çoğunluğunu farenjit tanısı alan 6-12 yaş arası çocukların oluşturduğu rapor edilmiştir (24) . On yedi ülkenin katılımıyla yapılan antibiyotik kullanımına yönelik bir çalışmada, Türkiye'nin en sık antibiyotik kullanımıyla birinci sırada yer aldığı bildirilmiştir.…”

Prevalence of Parental Misconceptions About Antibiotic Use

“…[3][4][5] Although recent studies demonstrate that antibiotic use has decreased and perhaps leveled off, additional reductions in use and improvements in antibiotic selection are believed possible. [6][7][8] Among the factors contributing to pediatric prescribing, parental attitudes and knowledge about common childhood illnesses may lead parents to mistakenly believe antibiotics are needed, [9][10][11][12][13][14][15][16][17] particularly for respiratory tract infections, the most common indication for antibiotics among young children. 6,8,16,18 Examples include the belief that antibiotics are needed to treat green nasal discharge, cough illnesses or bronchitis, and common colds or influenza.…”

“…[6][7][8] Among the factors contributing to pediatric prescribing, parental attitudes and knowledge about common childhood illnesses may lead parents to mistakenly believe antibiotics are needed, [9][10][11][12][13][14][15][16][17] particularly for respiratory tract infections, the most common indication for antibiotics among young children. 6,8,16,18 Examples include the belief that antibiotics are needed to treat green nasal discharge, cough illnesses or bronchitis, and common colds or influenza. 16,[18][19][20][21][22][23][24][25] Providers, in turn, may respond to their perception of parental expectations by prescribing unnecessary antibiotics.…”