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Variations in Antibiotic and Azithromycin Prescribing for Children by Geography and Specialty - United States, 2013.

Fleming-Dutra, Katherine E. MD; Demirjian, Alicia MD MMsc; Bartoces, Monina PhD; Roberts, Rebecca M. MS; Taylor, Thomas H. Jr PE MS; Hicks, Lauri A. DO
Pediatric Infectious Disease Journal: Post Acceptance: July 19, 2017
doi: 10.1097/INF.0000000000001708
Antimicrobial Reports: PDF Only

Background: Using antibiotics appropriately is critical to slow spread of antibiotic resistance, a major public health problem. Children, especially young children, receive more antibiotics than other age groups. Our objective was to describe antibiotic use in children in the United States (US) and use of azithromycin, which is recommended infrequently for pediatric conditions.

Methods: We used QuintilesIMS Xponent 2013 data to calculate the number and rate of oral antibiotic prescriptions for children by age (0-2, 3-9 and 10-19 years) and agent. We used log-binomial regression to calculate adjusted prevalence rations (PR) and 95% confidence intervals (CI) to determine if specialty and patient age were associated with azithromycin selection when an antibiotic was prescribed.

Results: In 2013, 66.8 million antibiotics were prescribed to US children aged <=19 years (813 antibiotic prescriptions per 1000 children). Amoxicillin and azithromycin were the two most commonly prescribed agents (23.1 million courses, 35% of all antibiotics; 12.2 million, 18%; respectively). Most antibiotics for children were prescribed by pediatricians (39%) and family practitioners (15%). Family practitioners were more likely to select azithromycin when an antibiotic was prescribed in all age groups than pediatricians (for children aged 0-2 years: PR 1.79, 95% CI, 1.78-1.80; 3-9 years: 1.40, 1.40-1.40; and 10-19 years: 1.18, 1.18-1.18).

Conclusion: Despite infrequent pediatric recommendations, variations in pediatric azithromycin use may suggest inappropriate antibiotic selection. Public health interventions focused on improving antibiotic selection in children as well as reducing antibiotic overuse are needed.

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