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Inappropriate Antibiotic Prescribing for Acute Bronchitis in Children and Impact on Subsequent Episodes of Care and Treatment

Morgan, Jake R., PhD*; Carey, Kathleen M., PhD*,†; Barlam, Tamar F., MD; Christiansen, Cindy L., PhD§; Drainoni, Mari-Lynn, PhD*,†,‡,¶

The Pediatric Infectious Disease Journal: March 2019 - Volume 38 - Issue 3 - p 271–274
doi: 10.1097/INF.0000000000002117
Antimicrobial Reports

Background: To examine whether inappropriate antibiotic treatment for an initial bout of acute bronchitis in childhood affects patterns of future healthcare utilization and antibiotic prescribing.

Methods: We conducted a retrospective analysis of children with at least 1 acute bronchitis episode, defined as the 14-day period after an acute bronchitis visit, born in 2008 and followed through 2015 in a nationally representative commercial claims database. We predicted the likelihood of returning for a subsequent acute bronchitis episode, and being prescribed an antibiotic as part of that episode, as a function of whether or not the child was prescribed an antibiotic as part of the first acute bronchitis episode controlling for patient, provider and practice characteristics.

Results: Children prescribed an antibiotic as part of their initial acute bronchitis episode were more likely both to have a subsequent acute bronchitis episode (hazard ratio = 1.23; 95% confidence interval: 1.17–1.30) and to be prescribed an antibiotic as part of that second episode (hazard ratio = 2.13; 95% confidence interval: 1.99–2.28) compared with children who were not prescribed as part of their first episode. Children diagnosed with asthma were more likely to experience a second visit for acute bronchitis, but less likely to receive an antibiotic as part of that second episode.

Conclusions: Inappropriate antibiotic prescribing for a child’s initial acute bronchitis episode of care predicted likelihood of subsequent acute bronchitis episodes and antibiotic prescriptions. Providers should consider the downstream effect of inappropriate antibiotic prescribing for acute bronchitis in childhood.

From the *Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts

Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford, Massachusetts

Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts

§Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts

Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, Massachusetts.

Accepted for publication May 1, 2018.

This research was supported in part by the Agency for Healthcare Research and Quality (grant number: T32HS022242) and by a dissertation support grant from the Jayne Koskinas Ted Giovanis Foundation for Health and Policy, a private foundation based in Highland, Maryland, dedicated to effecting change in the health care industry for the greater public good.

The authors have no conflicts of interest to disclose.

Address for correspondence: Jake R. Morgan, PhD, Department of Health Law, Policy and Management, Boston University School of Public Health, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118. E-mail:

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