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Inappropriate Antibiotic Prescribing for Acute Bronchitis in Children and Impact on Subsequent Episodes of Care and
Jake R Morgan1, Kathleen M Carey1,2, Tamar F Barlam3
1From the Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
Insights
Inappropriate antibiotic use for childhood acute bronchitis increases the risk of future acute bronchitis episodes and antibiotic prescriptions. Healthcare providers should consider these long-term effects when prescribing antibiotics for children.
Area of Science:
- Pediatric Healthcare
- Antibiotic Stewardship
- Respiratory Illnesses
Background:
- Acute bronchitis is a common childhood illness.
- Antibiotic prescribing for acute bronchitis is often inappropriate.
- The long-term consequences of initial antibiotic treatment are not well understood.
Purpose of the Study:
- To investigate if initial antibiotic treatment for acute bronchitis in children influences future healthcare use.
- To determine if early antibiotic prescribing affects subsequent antibiotic prescriptions for acute bronchitis.
Main Methods:
- Retrospective analysis of a large commercial claims database.
- Included children born in 2008, followed through 2015.
- Examined the association between initial antibiotic prescription and subsequent acute bronchitis episodes and antibiotic use, controlling for covariates.
Main Results:
- Children initially prescribed antibiotics were more likely to have subsequent acute bronchitis episodes (HR=1.23) and receive antibiotics for them (HR=2.13).
- Asthma diagnosis was associated with more frequent acute bronchitis visits but less antibiotic use in subsequent episodes.
Conclusions:
- Inappropriate antibiotic prescribing for initial acute bronchitis in children predicts future healthcare utilization and antibiotic prescriptions.
- Clinicians should consider the downstream impact of antibiotic prescribing decisions for pediatric acute bronchitis.
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.
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