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. 2019 Jan;143(1):e20181259.
doi: 10.1542/peds.2018-1259.

Trends in Outpatient Antibiotic Use in 3 Health Plans

Jonathan A Finkelstein  1   2 , Marsha A Raebel  3   4 , James D Nordin  5 , Matthew Lakoma  2 , Jessica G Young  2
Affiliations

Trends in Outpatient Antibiotic Use in 3 Health Plans

Jonathan A Finkelstein et al. Pediatrics. 2019 Jan.

Abstract

Objectives: Previous analyses of data from 3 large health plans suggested that the substantial downward trend in antibiotic use among children appeared to have attenuated by 2010. Now, data through 2014 from these same plans allow us to assess whether antibiotic use has declined further or remained stable.

Methods: Population-based antibiotic-dispensing rates were calculated from the same health plans for each study year between 2000 and 2014. For each health plan and age group, we fit Poisson regression models allowing 2 inflection points. We calculated the change in dispensing rates (and 95% confidence intervals) in the periods before the first inflection point, between the first and second inflection points, and after the second inflection point. We also examined whether the relative contribution to overall dispensing rates of common diagnoses for which antibiotics were prescribed changed over the study period.

Results: We observed dramatic decreases in antibiotic dispensing over the 14 study years. Despite previous evidence of a plateau in rates, there were substantial additional decreases between 2010 and 2014. Whereas antibiotic use rates decreased overall, the fraction of prescribing associated with individual diagnoses was relatively stable. Prescribing for diagnoses for which antibiotics are clearly not indicated appears to have decreased.

Conclusions: These data revealed another period of marked decline from 2010 to 2014 after a relative plateau for several years for most age groups. Efforts to decrease unnecessary prescribing continue to have an impact on antibiotic use in ambulatory practice.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Decline in antibiotic dispensing per person-year from 2000–2001 to 2013–2014 in 3 US health plans, by age group, with statistically identified changes in slope demarcated by geometric shapes (circles, squares, triangles) for each of the health plans, respectively. A, Patients 3 to <24 months. B, Patients 2 to <4 years old.
FIGURE 2
FIGURE 2
Decline in antibiotic dispensing per person-year from 2000–2001 to 2013–2014 in 3 US health plans, continued: by age group, with statistically identified changes in slope demarcated by geometric shapes (circles, squares, triangles) for each of the health plans, respectively. C, Patients 4 to <6 years old. D, Patients 6 to <12 years old. E, Patients 12 to <18 years old.
FIGURE 3
FIGURE 3
Diagnosis categories associated with antibiotic dispensing in 3 US health plans in 2000–2001 and 2013–2014, by age group (months).
See this image and copyright information in PMC

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