Pharmaceutical Research

Despite recent downward trends in antibiotic use among children, use of some broad-spectrum antibiotics has increased

Despite recent tends toward decreased antibiotic use among children to prevent growing bacterial resistance to antibiotics, the use of second-generation macrolides (for example, clarithromycin and azithromycin) among children has increased dramatically, according to a study conducted by researchers at the HMO Research Network Center for Education and Research on Therapeutics (CERT). The study was supported by the Agency for Healthcare Research and Quality (HS10391) as part of the Agency's CERTs initiative.

Experts generally do not recommend second-generation macrolides for initial treatment of infections in younger children. Nevertheless, these drugs have become popular because they are useful against a broad spectrum of bacteria, require less frequent dosing, and have fewer gastrointestinal side effects than other antibiotics, according to the researchers. They examined claims data on 25,000 children aged 3 months to 18 years treated as outpatients in nine U.S. health plans to assess trends in second-generation macrolide use from 1996 to 2000.

From 1995-1996 to 1999-2000, although overall antibiotic use decreased from 1.15 to 0.91 dispensings per person-year, use of second-generation macrolides increased from 0.022 to 0.063 dispensing per person-year. Also, second-generation macrolide use increased from 1.9 percent to 6.9 percent of all antibiotic dispensings.

For children under 6 years of age, second-generation macrolide use as initial therapy increased from 0.9 percent to 5 percent for otitis media and from 5.2 percent to 24 percent for pneumonia (Streptococcus pneumoniae strains resistant to macrolides increased in the late 1990s). Prescribing rates varied among health plans, ranging during the last year of the study from 0.006 to 0.135 dispensing per person-year. The researchers call for continued efforts to promote the use of narrower-spectrum agents when appropriate.

More details are in "Increased use of second-generation macrolide antibiotics for children in nine health plans in the United States," by Christopher J. Stille, M.D., M.P.H., Susan E. Andrade, Sc.D., Susan S. Huang, M.D., M.P.H., and others, in the November 2004 Pediatrics 114(5), pp. 1206-1211.

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