HealthDay News — Reductions in pediatric antibiotic prescribing rates achieved during the past decade may be coming to an end, study findings suggest.
Downward trends in antibiotic dispensing observed among 3- to 24-month old U.S. children in the early 2000s slowed, stabilized or reversed by 2010, Louise Elaine Vaz, MD, from Boston Children’s Hospital, and colleagues reported in Pediatrics.
“[A]fter years of declines in rates based on general messages that promote judicious prescribing, further progress may require focus on particular age groups, diagnoses or antibiotic classes,” the researchers wrote. “New interventions tailored to local prescribing patterns at the level of the health system, practice or clinician may also be needed.”
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To better understand trends in antibiotic prescribing, Vaz and colleagues analyzed pharmacy and outpatient claims from September 2000 to August 2010 to calculate antibiotic-dispensing rates per person-year for children aged 3 months to 18 years in health plans located in New England (A), the Mountain West (B), and the Midwest (C) regions of the United States.
Antibiotic use varied significantly at baseline between the health plans (A: 2.27, B: 1.40, C: 2.23 antibiotics per person-year; P<0.001).
During the study period, children aged 3 to <24 months experienced the greatest overall declines in antibiotic use, the researchers found. Early in the decade annual declines in prescribing rates for this age group were 5.0%, 9.3%, and 7.2%, respectively. However, by the end of the decade, these respective declines decreased to 2.4%, 2.1% and 0.5%.
In plans A, B and C, third-generation cephalosporin use for otitis media increased 1.6-, 15- and 5.5-fold, respectively, in young children. In other age groups, similar tempering of the decline in antibiotic use was seen, as well as increases in broad-spectrum agent use.
The researchers also looked at antibiotic prescribing trends by diagnosis. Among children aged <6 years, antibiotics were prescribed most frequently for otitis media (OM). For those aged 6 years and older, antibiotics were prescribed most frequently for pharyngitis.
Among children aged 3- to <24-months old antibiotic-dispensing rates per person-year for OM declined at all sites (P<0.001 for all) during the study period. However, these declines were mostly attributable to decreases in overall OM diagnoses rather than changes in treatment once OM was diagnosed, the researchers noted
“Because OM continues to be the primary driver of antibiotics dispensed (particularly for those aged <6 years), any additional decline in antibiotic rates will likely be driven by changes in diagnosis and management of this common infection,” they wrote.
Changes in antibiotic dispensing varied considerably among the three health plans in each of the age groups. Throughout the study period antibiotic dispensing for children aged 2 to <4 years was nearly one-third less than rates in the 3- to <24-month age group.
For each age group, children in plan B consistently had lower visit rates and antibiotic-dispensing rates compared with those in plans A and C. The reason for the differences are unknown, the researchers noted, but may represent differences in regional prescribing patterns, local health plan interventions or care-seeking patterns.
“Along with identifying best practices in low-prescribing areas, decreasing broad-spectrum use for particular conditions should be a continuing focus of intervention efforts,” the researchers wrote.
