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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*

The Pediatric Infectious Disease Journal: January 2018 - Volume 37 - Issue 1 - p 52–58
doi: 10.1097/INF.0000000000001708
Antimicrobial Reports

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 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 ratios and 95% confidence intervals 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 ≤19 years of age (813 antibiotic prescriptions per 1000 children). Amoxicillin and azithromycin were the 2 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 0–2 years of age: prevalence ratio: 1.79, 95% confidence interval: 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.

From the *Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, and §Division of Laboratory Systems, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia.

Accepted for publication February 20, 2017.

This work was funded by the Centers for Disease Control and Prevention. The Centers for Disease Control and Prevention was involved in the design of the study; analysis, and interpretation of the data; review of the article and decision to submit the article for publication. The authors have no conflicts of interest to disclose.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

K.E.F-D. interpreted the analyses, drafted the initial article and approved the final article as submitted. A.D. and L.A.H. conceptualized and designed the study, interpreted the analyses, reviewed and revised the article and approved the final article as submitted. M. B. carried out the analyses, reviewed and revised the article and approved the final article as submitted. R.M.B. and T.H.T. interpreted the analyses, reviewed and revised the article and approved the final article as submitted. K.E.F-D. and M. B. had full access to the all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Address for correspondence: Katherine E. Fleming-Dutra, MD, Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention; 1600 Clifton Road NE, Mailstop A-31, Atlanta, GA 30329–4018. E-mail: ftu2@cdc.gov.

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