Published online November 1, 2004
PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1206-1211 (doi:10.1542/peds.2004-0311)
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Increased Use of Second-Generation Macrolide Antibiotics for Children in Nine Health Plans in the United States

Christopher J. Stille, MD, MPH*,{ddagger},§, Susan E. Andrade, ScD*,{ddagger}, Susan S. Huang, MD, MPH*,||, James Nordin, MD, MPH*,¶, Marsha A. Raebel, PharmD*,#, Alan S. Go, MD**, K. Arnold Chan, MD, ScD*,{ddagger}{ddagger},§§ and Jonathan A. Finkelstein, MD, MPH**,||||

* HMO Research Network Center for Education and Research on Therapeutics
{ddagger} Meyers Primary Care Institute
§ Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
|| Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
HealthPartners Research Foundation, Minneapolis, Minnesota
# Clinical Research Unit, Kaiser Permanente of Colorado, Denver, Colorado
** Division of Research, Kaiser Permanente of Northern California, Oakland, California
{ddagger}{ddagger} Channing Laboratories, Brigham and Women’s Hospital, Boston, Massachusetts
§§ Harvard School of Public Health, Boston, Massachusetts
|||| Division of General Pediatrics, Children’s Hospital, Boston, Massachusetts

Background. Widespread use of broad-spectrum antibiotics contributes to increasing rates of bacterial resistance to antibiotics. Second-generation macrolides have become popular for use among children because of their broad spectrum and favorable dosing and side-effect profiles, although experts do not generally recommend them for use as initial treatment of infections among younger children.

Objective. To assess trends in second-generation macrolide use from 1996 to 2000 among children treated as outpatients in 9 US health plans, including associated diagnoses and use as initial treatment.

Methods. We sampled claims data for 25000 children, 3 months to <18 years of age, who were enrolled between September 1, 1995, and August 31, 2000, in each of 9 US health plans. Medications dispensed were linked with ambulatory visit claims to assign diagnoses. Dispensings without another antibiotic dispensing recorded in the previous 42 days were analyzed as initial treatment of a new illness episode. We analyzed trends in prescribing overall, for initial therapy, and, within specific diagnoses, for differences among health plans.

Results. From 1995–1996 to 1999–2000, although overall antibiotic use decreased from 1.15 to 0.91 dispensings per person-year, second-generation macrolide use increased from 0.022 to 0.063 dispensings per person-year. Use as a proportion of all antibiotic dispensings increased from 1.9% to 6.9%, and use as initial therapy increased from 1.4% to 6%. For children <6 years of age, second-generation macrolide use as initial therapy increased from 0.9% to 5.0% for otitis media and from 5.2% to 24.0% for pneumonia. There was a wide range of prescribing rates among health plans during the last year of the study, from 0.006 to 0.135 dispensings per person-year.

Conclusions. Despite recent trends toward decreased antibiotic use among children, the use of second-generation macrolides among children has increased dramatically, even among younger children, for whom use for initial treatment of illness is not recommended. Large differences in prescribing rates exist among health plans. Continued efforts to promote the use of narrower-spectrum agents when appropriate are needed.

Key Words: antibiotics • macrolides • respiratory infection • managed care

Accepted May 10, 2004.




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