Antibiotics Prescribed for Kids at Twice Expected Rate

Antibiotics are prescribed almost twice as often as expected to outpatients aged 18 years and younger nationally, according to results of a new study published online September 15 in Pediatrics.

That translates to about 11.4 million potentially unnecessary antibiotic prescriptions every year, a number that has not decreased substantially over the course of 10 years.

Matthew P. Kronman, MD, MSCE, from the Division of Infectious Diseases, Seattle Children's Hospital, Washington, and colleagues performed a meta-analysis of studies from 2000 to 2011 to determine bacterial rates for 5 common childhood acute respiratory tract infections (ARTIs): acute otitis media (AOM), sinusitis, bronchitis, upper respiratory tract infection, and pharyngitis. Bacterial infections can be treated with antibiotics, but viral infections cannot.

The authors also looked at data on children aged 18 years and younger seen in ambulatory clinics from 2000 to 2010 to estimate antibiotic prescribing rates.

On the basis of ear and throat bacterial prevalence and evidence that pneumococcal vaccine prevents many bacterial infections, the researchers estimated that 27.4% of US kids have bacterial illness (95% confidence interval [CI], 26.5% - 28.3%). Yet antibiotics are prescribed for 56.9% of ARTI visits (95% CI, 50.8% - 63.1%).

Authors determined prescribing rates with the National Ambulatory Medical Care Survey, administered by the National Center for Health Statistics, which collects patient visit data from community, non–federally funded, ofﬁce-based physicians.

Part of the problem is the lack of tools for physicians to differentiate bacterial infections from viral infections, other than the rapid strep test. Although that test offers a specific way to identify pharyngitis episodes that require antibiotics, tympanocentesis and sinus puncture are not practical for routine use in ambulatory settings, the authors write.

However, they note, "our sensitivity analysis, assuming that all children who have sinusitis and all those <2 years of age who have AOM should be prescribed antimicrobial agents, still demonstrated an estimated 9.4 million potentially preventable antimicrobial prescriptions annually from among those who had bronchitis, [upper respiratory infection], pharyngitis, and those >2 years of age who had AOM."

Curbing unnecessary prescriptions for outpatient pediatric ARTI is urgent, the authors conclude, because more than half of all outpatient antimicrobial prescribing to children is for ARTIs, representing more than 25 million visits each year.

Overprescribing also has implications for public health.

"Antimicrobial use is associated with increased resistance among bacteria that cause ARTI, posing both individual and community risks," the authors write.

Supported in part by the Seattle Children's Research Institute Center for Clinical and Translational Research Clinical Research Scholars Program to Dr. Kronman. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online September 15, 2014.

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