Feature Story

Fewer antibiotics are being prescribed for U.S. children

After decades of being on the rise, antibiotic use by American children fell by almost 25 percent from 1996 to 2000, according to a new study supported by the Agency for Healthcare Research and Quality (HS10391). More than half of the decrease came from a drop in antibiotics prescribed for childhood ear infections. Attention to the link between antibiotic resistance and antibiotic overprescribing by public health and professional groups and the news media may have contributed to this decline in antibiotic prescribing, explains Jonathan A. Finkelstein, M.D., M.P.H., of Harvard Medical School.

In this study, Dr. Finkelstein and his colleagues analyzed claims data for dispensed medication and physician visits from nine health maintenance organizations (HMOs), which are part of the HMO Research Network. The Network is one of seven Centers for Education and Research on Therapeutics (CERTs) supported by AHRQ. Each HMO provided data on 25,000 children aged 3 months up to 18 years enrolled between September 1, 1995, and August 31, 2000. The researchers linked antibiotic prescriptions with diagnoses made during outpatient visits and calculated the contribution of each diagnosis to changes in the overall rate of antibiotic use.

From 1996 to 2000, rates of antibiotic use for children 3 months to less than 3 years decreased from 2.46 to 1.89 antibiotics (24 percent); for children 3 years to less than 6 years from 1.47 to 1.09 antibiotics (25 percent); and for children 6 to 18 years from 0.85 to 0.69 antibiotics (16 percent). In the youngest age group, a drop in antibiotic prescriptions for ear infections accounted for 59 percent of the total decrease. Fewer antibiotic prescriptions for cold/upper respiratory infection accounted for 8 percent of the decline; pharyngitis, 6 percent; sinusitis, 3 percent; and bronchitis, 4 percent. Also, use of first-line penicillin for antibiotic prescribing, as recommended by national guidelines, increased from 49 to 53 percent.

More details are in "Reduction in antibiotic use among U.S. children, 1996-2000," by Dr. Finkelstein, Christopher Stille, M.D., M.P.H., James Nordin, M.D., M.P.H., and others, in the September 2003 Pediatrics 112(3), pp. 620-627.

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