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Trends in antimicrobial prescribing rates for children and adolescents
Linda F McCaig1, Richard E Besser, James M Hughes
1Ambulatory Care Statistics Branch, Division of Health Care Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 6525 Belcrest Rd, Room 952, Hyattsville, MD 20782, USA. lfm1@cdc.gov
Context:
Annual rates of antimicrobial prescribing for children by office-based physicians increased from 1980 through 1992. The development of antimicrobial resistance, which increased for many organisms during the 1990s, is associated with antimicrobial use. To combat development of antimicrobial resistance, professional and public health organizations undertook efforts to promote appropriate antimicrobial prescribing.
Objective:
To assess changes in antimicrobial prescribing rates overall and for respiratory tract infections for children and adolescents younger than 15 years.
Design, Setting, And Participants:
National Ambulatory Medical Care Survey data provided by 2500 to 3500 office-based physicians for 6500 to 13 600 pediatric visits during 2-year periods from 1989-1990 through 1999-2000.
Main Outcome Measures:
Population- and visit-based antimicrobial prescribing rates overall and for respiratory tract infections (otitis media, pharyngitis, bronchitis, sinusitis, and upper respiratory tract infection) among children and adolescents younger than 15 years.
Results:
The average population-based annual rate of overall antimicrobial prescriptions per 1000 children and adolescents younger than 15 years decreased from 838 (95% confidence interval [CI], 711-966) in 1989-1990 to 503 (95% CI, 419-588) in 1999-2000 (P for slope <.001). The visit-based rate decreased from 330 antimicrobial prescriptions per 1000 office visits (95% CI, 305-355) to 234 (95% CI, 210-257; P for slope <.001). For the 5 respiratory tract infections, the population-based prescribing rate decreased from 674 (95% CI, 568-781) to 379 (95% CI, 311-447; P for slope <.001) and the visit-based prescribing rate decreased from 715 (95% CI, 682-748) to 613 (95% CI, 570-657; P for slope <.001). Both population- and visit-based prescribing rates decreased for pharyngitis and upper respiratory tract infection; however, for otitis media and bronchitis, declines were only observed in the population-based rate. Prescribing rates for sinusitis remained stable.
Conclusion:
The rate of antimicrobial prescribing overall and for respiratory tract infections by office-based physicians for children and adolescents younger than 15 years decreased significantly between 1989-1990 and 1999-2000.
Insights
Antimicrobial prescribing for children decreased significantly from 1989-2000, with notable reductions for respiratory infections. This study highlights successful efforts to curb inappropriate antimicrobial use in pediatric care.
Area of Science:
- Pediatric Health
- Infectious Diseases
- Public Health Policy
Background:
- Antimicrobial prescribing rates for children increased significantly from 1980 to 1992.
- Rising antimicrobial resistance in the 1990s was linked to increased antimicrobial use.
- Public health initiatives aimed to promote appropriate antimicrobial prescribing to combat resistance.
Purpose of the Study:
- To evaluate changes in antimicrobial prescribing rates in children and adolescents younger than 15 years.
- To specifically assess prescribing trends for common respiratory tract infections.
Main Methods:
- Analysis of National Ambulatory Medical Care Survey data from 1989-1990 to 1999-2000.
- Inclusion of data from 2500-3500 office-based physicians and 6500-13,600 pediatric visits per period.
- Examination of population- and visit-based prescribing rates for overall and specific respiratory infections.
Main Results:
- Overall population-based prescribing rates decreased from 838 to 503 per 1000 children (P <.001).
- Visit-based prescribing rates dropped from 330 to 234 per 1000 visits (P <.001).
- Significant declines were observed for pharyngitis and upper respiratory infections, with mixed results for otitis media and bronchitis, and stable rates for sinusitis.
Conclusions:
- Antimicrobial prescribing rates for children and adolescents significantly decreased between 1989-1990 and 1999-2000.
- These findings indicate a successful reduction in antimicrobial use for pediatric respiratory conditions.
- The study underscores the impact of public health efforts on antimicrobial stewardship in pediatric care.
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