Recent trends in outpatient antibiotic use in children

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 to August 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 broad-spectrum 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.

Keywords: antibiotics; otitis media; respiratory tract infections.

FIGURE 1

Rates of antibiotic dispensing per person-year of enrollment for children aged as follows: A, 3 to 24 months; B, 2 to <4 years; C, 4 to <6 years; D, 6 to <12 years; and E, 12 to <18 years. Values are for each health plan (A–C) between 2000 and 2010. Note: axes differ for the last 2 age groups. Enhanced marker reflects year of greatest change in decline of antibiotic rate. Although 95% CIs were calculated, the results were too small to be visible on graphs.

FIGURE 2

Distribution of diagnoses and antibiotic prescriptions in 2009–2010 among 3 health plans. UTI, urinary tract infection.

FIGURE 3

Distribution of antibiotic classes among health plans, 2000–2001 and 2009–2010, for children aged as follows: A, 3 to <24 months; B, 2 to <4 years; C, 4 to <6 years; D, 6 to <12 years; and E, 12 to <18 years. Changes in dispensing rate between 2000–2001 and 2009–2010 were statistically significant (P < .05) for all antibiotic classes. Note: y-axis scaled differently in lower panels. AMOX-CLAV, amoxicillin/clavulanate; CEPH, cephalosporins; GEN, generation; PCN, 1st - line penicillins.