Reduction in antibiotic use among US children, 1996-2000

Jonathan A. Finkelstein, Christopher Stille, James Nordin, Robert Davis, Marsha A. Raebel, Douglas Roblin, Alan S. Go, David Smith, Christine C. Johnson, Kenneth Kleinman, K. Arnold Chan, Richard Platt

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Background. High rates of antibiotic prescribing to children contribute to antibiotic resistance in the community. The Centers for Disease Control and Prevention, in collaboration with other national and state level organizations, have actively promoted more judicious prescribing for children. Objective. We sought to assess changes in the rate of antibiotic prescribing from 1996-2000 in 9 US health plans, patterns of diagnosis and treatment responsible for these trends, and changes in the use of first-line antimicrobial agents. Design/Methods. We analyzed claims data for dispensed medications and physician visits from 9 health plans. Each provided data on 25 000 children aged 3 months to < 18 years enrolled between September 1, 1995, and August 31, 2000. Antibiotic dispensings were linked with an ambulatory visit claim to assign diagnosis. Antibiotic dispensings per person-year (antibiotics/p-y) were calculated for the age groups 3 months to <3 years, 3 years to <6 years, and 6 years to <18 years. The contribution of each diagnosis to changes in the overall rate of antibiotic use was determined. Generalized linear mixed models were used to test for trend and assess differences in rates by site. Results. From 1996-2000, antibiotic rates for children 3 months to <3 years decreased from 2.46 to 1.89 antibiotics/p-y (24%); for children 3 years to <6 years from 1.47 to 1.09 antibiotics/p-y (25%); and for children 6 to <18 years from 0.85 to 0.69 antibiotics/p-y (16%). The reduction varied among health plans from 6% to 39% for children 3 months to <3 years. A decrease in prescriptions for otitis media accounted for 59% of the total decrease, and was primarily accounted for by a decrease in the rate of diagnosis of this condition. The proportion of first-line penicillins increased from 49% to 53%, with health plans with the lowest initial rates increasing most. Conclusions. Antibiotic prescribing decreased significantly between 1996 and 2000, concurrent with decreased frequency of diagnosis of potential bacterial infections, especially otitis media. Attention by public health and professional organizations and the news media to antibiotic resistance may have contributed to changes in diagnostic thresholds, resulting in more judicious prescribing.

Original languageEnglish (US)
Pages (from-to)620-627
Number of pages8
JournalPediatrics
Volume112
Issue number3 I
DOIs
StatePublished - Sep 1 2003
Externally publishedYes

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Anti-Bacterial Agents
Health
Otitis Media
Microbial Drug Resistance
Centers for Disease Control and Prevention (U.S.)
Anti-Infective Agents
Bacterial Infections
Penicillins
Prescriptions
Linear Models
Public Health
Age Groups
Organizations
Physicians

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Finkelstein, J. A., Stille, C., Nordin, J., Davis, R., Raebel, M. A., Roblin, D., ... Platt, R. (2003). Reduction in antibiotic use among US children, 1996-2000. Pediatrics, 112(3 I), 620-627. https://doi.org/10.1542/peds.112.3.620

Reduction in antibiotic use among US children, 1996-2000. / Finkelstein, Jonathan A.; Stille, Christopher; Nordin, James; Davis, Robert; Raebel, Marsha A.; Roblin, Douglas; Go, Alan S.; Smith, David; Johnson, Christine C.; Kleinman, Kenneth; Chan, K. Arnold; Platt, Richard.

In: Pediatrics, Vol. 112, No. 3 I, 01.09.2003, p. 620-627.

Research output: Contribution to journalArticle

Finkelstein, JA, Stille, C, Nordin, J, Davis, R, Raebel, MA, Roblin, D, Go, AS, Smith, D, Johnson, CC, Kleinman, K, Chan, KA & Platt, R 2003, 'Reduction in antibiotic use among US children, 1996-2000', Pediatrics, vol. 112, no. 3 I, pp. 620-627. https://doi.org/10.1542/peds.112.3.620
Finkelstein JA, Stille C, Nordin J, Davis R, Raebel MA, Roblin D et al. Reduction in antibiotic use among US children, 1996-2000. Pediatrics. 2003 Sep 1;112(3 I):620-627. https://doi.org/10.1542/peds.112.3.620
Finkelstein, Jonathan A. ; Stille, Christopher ; Nordin, James ; Davis, Robert ; Raebel, Marsha A. ; Roblin, Douglas ; Go, Alan S. ; Smith, David ; Johnson, Christine C. ; Kleinman, Kenneth ; Chan, K. Arnold ; Platt, Richard. / Reduction in antibiotic use among US children, 1996-2000. In: Pediatrics. 2003 ; Vol. 112, No. 3 I. pp. 620-627.
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abstract = "Background. High rates of antibiotic prescribing to children contribute to antibiotic resistance in the community. The Centers for Disease Control and Prevention, in collaboration with other national and state level organizations, have actively promoted more judicious prescribing for children. Objective. We sought to assess changes in the rate of antibiotic prescribing from 1996-2000 in 9 US health plans, patterns of diagnosis and treatment responsible for these trends, and changes in the use of first-line antimicrobial agents. Design/Methods. We analyzed claims data for dispensed medications and physician visits from 9 health plans. Each provided data on 25 000 children aged 3 months to < 18 years enrolled between September 1, 1995, and August 31, 2000. Antibiotic dispensings were linked with an ambulatory visit claim to assign diagnosis. Antibiotic dispensings per person-year (antibiotics/p-y) were calculated for the age groups 3 months to <3 years, 3 years to <6 years, and 6 years to <18 years. The contribution of each diagnosis to changes in the overall rate of antibiotic use was determined. Generalized linear mixed models were used to test for trend and assess differences in rates by site. Results. From 1996-2000, antibiotic rates for children 3 months to <3 years decreased from 2.46 to 1.89 antibiotics/p-y (24{\%}); for children 3 years to <6 years from 1.47 to 1.09 antibiotics/p-y (25{\%}); and for children 6 to <18 years from 0.85 to 0.69 antibiotics/p-y (16{\%}). The reduction varied among health plans from 6{\%} to 39{\%} for children 3 months to <3 years. A decrease in prescriptions for otitis media accounted for 59{\%} of the total decrease, and was primarily accounted for by a decrease in the rate of diagnosis of this condition. The proportion of first-line penicillins increased from 49{\%} to 53{\%}, with health plans with the lowest initial rates increasing most. Conclusions. Antibiotic prescribing decreased significantly between 1996 and 2000, concurrent with decreased frequency of diagnosis of potential bacterial infections, especially otitis media. Attention by public health and professional organizations and the news media to antibiotic resistance may have contributed to changes in diagnostic thresholds, resulting in more judicious prescribing.",
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AU - Roblin, Douglas

AU - Go, Alan S.

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N2 - Background. High rates of antibiotic prescribing to children contribute to antibiotic resistance in the community. The Centers for Disease Control and Prevention, in collaboration with other national and state level organizations, have actively promoted more judicious prescribing for children. Objective. We sought to assess changes in the rate of antibiotic prescribing from 1996-2000 in 9 US health plans, patterns of diagnosis and treatment responsible for these trends, and changes in the use of first-line antimicrobial agents. Design/Methods. We analyzed claims data for dispensed medications and physician visits from 9 health plans. Each provided data on 25 000 children aged 3 months to < 18 years enrolled between September 1, 1995, and August 31, 2000. Antibiotic dispensings were linked with an ambulatory visit claim to assign diagnosis. Antibiotic dispensings per person-year (antibiotics/p-y) were calculated for the age groups 3 months to <3 years, 3 years to <6 years, and 6 years to <18 years. The contribution of each diagnosis to changes in the overall rate of antibiotic use was determined. Generalized linear mixed models were used to test for trend and assess differences in rates by site. Results. From 1996-2000, antibiotic rates for children 3 months to <3 years decreased from 2.46 to 1.89 antibiotics/p-y (24%); for children 3 years to <6 years from 1.47 to 1.09 antibiotics/p-y (25%); and for children 6 to <18 years from 0.85 to 0.69 antibiotics/p-y (16%). The reduction varied among health plans from 6% to 39% for children 3 months to <3 years. A decrease in prescriptions for otitis media accounted for 59% of the total decrease, and was primarily accounted for by a decrease in the rate of diagnosis of this condition. The proportion of first-line penicillins increased from 49% to 53%, with health plans with the lowest initial rates increasing most. Conclusions. Antibiotic prescribing decreased significantly between 1996 and 2000, concurrent with decreased frequency of diagnosis of potential bacterial infections, especially otitis media. Attention by public health and professional organizations and the news media to antibiotic resistance may have contributed to changes in diagnostic thresholds, resulting in more judicious prescribing.

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