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. 2012 Jul;130(1):15-22.
doi: 10.1542/peds.2011-3137. Epub 2012 Jun 25.

Trends in antibiotic use in Massachusetts children, 2000-2009

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Trends in antibiotic use in Massachusetts children, 2000-2009

Sharon K Greene et al. Pediatrics. 2012 Jul.

Abstract

Objective: Antibiotic use rates have declined dramatically since the 1990s. We aimed to determine if, when, and at what level the decline in antibiotic-dispensing rates ended and which diagnoses contributed to the trends.

Methods: Antibiotic dispensings and diagnoses were obtained from 2 health insurers for 3- to <72-month-olds in 16 Massachusetts communities from 2000 to 2009. Population-based antibiotic-dispensing rates per person-year (p-y) were determined according to year (September-August) for 3 age groups. Fit statistics were used to identify the most likely year for a change in trend. Rates for the first and last years were compared according to antibiotic category and associated diagnosis.

Results: From 2000-2001 to 2008-2009, the antibiotic-dispensing rate for 3- to <24-month-olds decreased 24% (2.3-1.8 antibiotic dispensings per p-y); for 24- to <48-month-olds, it decreased 18% (1.6-1.3 antibiotic dispensings per p-y); and for 48- to <72-month-olds, it decreased 20% (1.4-1.1 antibiotic dispensings per p-y). For 3- to <48-month-olds, rates declined until 2004-2005 and remained stable thereafter; the downward trend for 48- to <72-month-olds ended earlier in 2001-2002. Among 3- to <24-month-olds, first-line penicillin use declined 26%. For otitis media, the dispensing rate decreased 14% and the diagnosis rate declined 9%, whereas the treatment fraction was stable at 63%.

Conclusions: The downward trend in antibiotic dispensings to young children in these communities ended by 2004-2005. This trend was driven by a declining otitis media diagnosis rate. Continued monitoring of population-based dispensing rates will support efforts to avoid returning to previous levels of antibiotic overuse.

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Figures

FIGURE 1
FIGURE 1
Total antibiotic dispensings per p-y for members of 2 large health insurers in 16 Massachusetts communities, 2000–2001 to 2008–2009, according to 3 pediatric age groups. Dispensing rates with 95% confidence intervals are shown. Arrows indicate the most likely year for a change in linear trend for each age group. a The confidence intervals for 2003–2004 are wider than those for other years because data from only 1 insurer were available.
FIGURE 2
FIGURE 2
Predicted probabilities for the first (2000–2001) and last (2008–2009) study years of the total number of antibiotic dispensings per p-y for the average person in each age group.
FIGURE 3
FIGURE 3
Values for antibiotic dispensings/p-y for the first (2000–2001) and last (2008–2009) study years for 7 antibiotic categories. Dispensing rates with 95% confidence intervals are shown, along with P values for the difference in rates within each antibiotic category. A, 3- to <24-month-olds; B, 24 to <48-month-olds; C, 48- to <72-month-olds. TMP/SMX, trimethoprim-sulfamethoxazole.
FIGURE 4
FIGURE 4
Total antibiotic dispensings per p-y for the first and last study years according to diagnosis. Dispensing rates with 95% confidence intervals are shown, along with P values for the difference in rates within each diagnosis category. A, 3- to <24-month-olds; B, 24- to <48-month-olds; C, 48- to <72-month-olds.

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