COMMENTARY

The Drugs We Prescribe to Children: What Has Changed?

William T. Basco, Jr, MD, MS

Disclosures

August 20, 2018

Results by Drug Class

These questions were the impetus for a recent report[1] that examined data from the National Health and Nutrition Examination Survey (NHANES), collected from 1999-2014, capturing medications used in the 30 days before the interview.

The NHANES data comprised more than 38,000 participant children, with a mean age of 10 years. In the most recent years (2011-2014), 21.9% of the children took at least one medication in the month before the interview. Use of any medication was highest among non-Hispanic white children (25.3%), compared with 21.1% among non-Hispanic black children,16.8% among Hispanic children, and 13.2% among Asian children.

Insured participants were much more likely to use medications than those who were uninsured (23.1% vs 9.7%). During the study years, there was a general decline in all medication use, from 24.6% in 1999-2002 to 21.9% in the most recent period.

Declines in use of almost all therapeutic classes were seen. For example, antibiotic use declined by 47%, from 8.4% of children in 1999-2002 to 4.5% in 2011-2014, a statistically significant trend. The use of narcotic-containing analgesics decreased over time, but not significantly (from 1% to 0.6%).

In contrast, prescription of asthma medications increased, from 4.3% to 6.1% of children over the 15 years—an increase that was seen in multiple types of asthma medications, including inhaled corticosteroids (from 1% to 1.7%), montelukast (from 0.6% to 1.9%), and an insignificant rise in albuterol (from 3.5% to 3.8%).

Several other drug classes demonstrated increases. The use of H2 antagonists increased over time from 1.1% to 2.1%, as did antipsychotics (0.4% to 0.6%), but both classes just missed significance (P = .06).

Other drug classes that increased in use during the 15 years, but not significantly, included antihypertensives (0.2% to 0.4%) and antidiabetic agents (0.2% to 0.4%).

Finally, medications for attention-deficit/hyperactivity disorder (ADHD) demonstrated a statistically significant increase, from 2.8% to 3.5% (P for trend = .02), as did proton pump inhibitors (0.2% to 0.7%; P for trend = .004).

The authors concluded that there has been an overall decline in the use of prescription medications among US children between 1999-2014.

Viewpoint

I reviewed this study primarily because it received a good deal of lay press, with much of that focused on the decline in antibiotic use (by almost 50%), and that is certainly something to celebrate. I would bet that most pediatric providers would not be too surprised about the drug classes that we are prescribing more of (eg, ADHD and asthma medications), but it is worth considering why we saw a more than 100% increase in use of proton pump inhibitors. The increased use of antihypertensives probably represents both better recognition of hypertension in youth as well as the increasing prevalence of obesity, and the increased use of antidiabetic agents may be entirely due to trends in obesity.

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