Reduction in Antibiotic Use Among US Children, 1996–2000
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* HMO Research Network Centers for Education and Research on Therapeutics
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
Division of General Pediatrics, Children’s Hospital Boston, Boston Massachusetts
|| Meyers Primary Care Institute and Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
¶ HealthPartners Research Foundation, Minneapolis, Minnesota
# Group Health Cooperative and Departments of Pediatrics and Epidemiology, Schools of Medicine and Public Health, University of Washington, Seattle, Washington
** Clinical Research Unit, Kaiser Permanente of Colorado, Denver, Colorado
Kaiser Permanente Georgia Region, Atlanta, Georgia
Division of Research, Kaiser Permanente Northern California, Oakland, California
|||| Kaiser Permanente Center for Health Research, Portland, Oregon
¶¶ Henry Ford Health System, Detroit, Michigan
## Channing Laboratories, Brigham and Women’s Hospital, Boston, Massachusetts
*** Harvard School of Public Health, Boston, Massachusetts
Background. High rates of antibiotic prescribing to children contribute to antibiotic resistance in the community. The Centers for Disease Control and Prevention, in collaboration with other national and state level organizations, have actively promoted more judicious prescribing for children.
Objective. We sought to assess changes in the rate of antibiotic prescribing from 1996–2000 in 9 US health plans, patterns of diagnosis and treatment responsible for these trends, and changes in the use of first-line antimicrobial agents.
Design/Methods. We analyzed claims data for dispensed medications and physician visits from 9 health plans. Each provided data on 25 000 children aged 3 months to <18 years enrolled between September 1, 1995, and August 31, 2000. Antibiotic dispensings were linked with an ambulatory visit claim to assign diagnosis. Antibiotic dispensings per person-year (antibiotics/p-y) were calculated for the age groups 3 months to <3 years, 3 years to <6 years, and 6 years to <18 years. The contribution of each diagnosis to changes in the overall rate of antibiotic use was determined. Generalized linear mixed models were used to test for trend and assess differences in rates by site.
Results. From 1996–2000, antibiotic rates for children 3 months to <3 years decreased from 2.46 to 1.89 antibiotics/p-y (24%); for children 3 years to <6 years from 1.47 to 1.09 antibiotics/p-y (25%); and for children 6 to <18 years from 0.85 to 0.69 antibiotics/p-y (16%). The reduction varied among health plans from 6% to 39% for children 3 months to <3 years. A decrease in prescriptions for otitis media accounted for 59% of the total decrease, and was primarily accounted for by a decrease in the rate of diagnosis of this condition. The proportion of first-line penicillins increased from 49% to 53%, with health plans with the lowest initial rates increasing most.
Conclusions. Antibiotic prescribing decreased significantly between 1996 and 2000, concurrent with decreased frequency of diagnosis of potential bacterial infections, especially otitis media. Attention by public health and professional organizations and the news media to antibiotic resistance may have contributed to changes in diagnostic thresholds, resulting in more judicious prescribing.
Key Words: antibiotics • otitis media • upper respiratory infection
Abbreviations: CDC, Centers for Disease Control and Prevention • URI, upper respiratory infection • NAMCS, National Ambulatory Medical Care Survey • HMO, Health Maintenance Organization • CERTs, Centers for Education and Research on Therapeutics • NDC, National Drug Code • ICD-9, International Classification of Diseases, Ninth Revision • OME, otitis media with effusion • p-y, person-years
Received for publication ; Accepted May 27, 2003.
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