Inappropriate antibiotics prescribed to the pediatric population inconsistent with “first, do no harm”

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Inappropriate and substandard antibiotic prescribing in pediatrics was associated with an eight-fold increased risk of adverse drug events, including C difficile infectionand higher health care costs, in a new study Washington University in St Louis and the Pew Charitable Trusts.

Lead author Anne Butler, PhD, and colleagues at Washington University, St Louis joined David Hyun, MD and Rachel Zetts of the Pew Charitable Trusts to compare outcomes between inappropriate antibiotics and compliant prescribing. guidelines in a cohort of more than 2.8 million children treated for common bacterial or viral infections in outpatient settings.

“Despite the inappropriate prescribing of antibiotics for the treatment of pediatric infections on an outpatient basis, the evidence is limited on the risk associated with inappropriate antibiotic prescribing,” Butler and colleagues observed.

In addition to differentiating outcomes and determining the relative risks of individual adverse drug events, the investigators explained, “We also sought to estimate the annual expenditures nationally attributable to inappropriate antibiotic prescriptions…”

In an article published simultaneously Insight of the study, the Pew Charitable Trusts also notes that antibiotic use leads to the development of antibiotic-resistant bacteria that cause more than 2.8 million infections and 35,000 deaths in the United States each year.

“As a result, it is critical to improve antibiotic stewardship efforts, which help ensure that these drugs are prescribed appropriately,” the statesmen say.

To distinguish findings between appropriate and inappropriate antibiotic prescribing in pediatric outpatients, investigators searched the IBM MarketScan commercial database from 2015 to 2018, identifying children 6 months to 17 years old diagnosed with an infection in outpatient settings. common bacterial (suppurative otitis media (OM), pharyngitis, sinusitis) or viral (influenza, viral upper respiratory tract infection (URI), bronchiolitis from 6 months to 3 years, bronchitis from 5 to 17 years and non-suppurative otitis media).

Exposure to antibiotics corresponded to a prescription on the day of the index diagnosis. The researchers excluded index events with multiple oral antibiotic prescriptions or unusual treatment durations, as well as index events with other diagnoses for which antibiotics are warranted. Safety results were derived from medical claims within 2-90 days. Health care costs were calculated as the sum of patients’ out-of-pocket expenses and health plan expenses.

Butler and colleagues found that antibiotics were prescribed inappropriately for 31-36% of bacterial infections and 4-70% for vial infections. Compared to an appropriate prescription, inappropriate antibiotics have been associated with an increased risk of several adverse events, including it’s hard infection (HR 6.23, 95% CI 2.24-17.32) and serious allergic reactions (HR 4.14, 2.48-6.92).

Attributable health care expenditures were generally higher with inappropriate antibiotics ($21-56 for bacterial infections; $96-97 for viral infections). They predicted that annual attributable national expenditures were highest for suppurative OM ($25.3 million), pharyngitis ($21.3 million), and viral URI ($19.1 million). .

In a press Release from Washington University School of Medicine in St. Louis, Butler reflected on their findings and distinguished between appropriate and inappropriate antibiotic prescribing.

“Sometimes parents think the worst that can happen is that the antibiotic just won’t help their child, but antibiotics are not harmless, they can cause adverse drug reactions,” Butler commented. “Clinicians must ensure that antibiotics are only used in the way most likely to benefit the patient.”

In accompaniment, guest commentMichael Smith, MD, MSCE, Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Pediatric Infectious Diseases, Department of Pediatrics Duke University Medical Center, Durham, NC, and Bethany Wattles, PharmD, MHA, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, highlighted study findings that appropriate antibiotic prescribing reduces both complications and costs.

“This work identifies a clear opportunity to improve the quality of child care for common infections while leading to significant cost savings. In the era of value-based care, this is mission critical,” say Smith and Wattles.

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