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Published on: April 18, 2019
Recurrent Antibiotic Use in Kentucky Children With 6 Years of Continuous Medicaid Enrollment
Bethany A Wattles1, Michael J Smith2, Yana Feygin3
1Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Insights
Antibiotic use is frequent in children insured by Medicaid, with higher rates in younger, White, rural, and chronically ill children. Targeted antibiotic stewardship is crucial for these high-use groups.
Area of Science:
- Pediatric Health
- Pharmacology
- Public Health
Background:
- Antibiotic use patterns in children over time are not well understood.
- The amoxicillin index is a new metric for evaluating first-line antibiotic prescribing in pediatric populations.
Purpose of the Study:
- To analyze the distribution of antibiotic prescriptions among children enrolled in Medicaid over a six-year period.
- To identify demographic and clinical factors associated with higher antibiotic use in children.
Main Methods:
- A cohort of continuously enrolled Medicaid children (2012-2017) was established using enrollment claims.
- Pharmacy claims data were utilized to track antibiotic prescription history for each child.
Main Results:
- Over 169,000 children were analyzed; 6.4% received no antibiotic prescriptions, while 8.9% received more than 20.
- Median antibiotic fills were 6 over six years, with higher use observed in younger, White, rural, and chronically ill children.
- Higher antibiotic use groups demonstrated lower rates of amoxicillin fills, indicated by lower amoxicillin indices.
Conclusions:
- Antibiotic consumption is prevalent among Kentucky Medicaid-insured children.
- Increased antibiotic fills were noted in younger, White, rural children, and those with chronic conditions.
- Children with high, recurrent antibiotic use represent key targets for antibiotic stewardship interventions.
Background:
Little is known about the distribution of antibiotic use in individual children over time. The amoxicillin index is a recently proposed metric to assess first-line antibiotic prescribing to children.
Methods:
We constructed a cohort of continuously enrolled Medicaid children using enrollment claims from 2012 to 2017. Pharmacy claims were used to identify antibiotic prescription data.
Results:
Among 169 724 children with 6 years of Medicaid enrollment, 10 804 (6.4%) had no antibiotic prescription claims during the study period; 43 473 (25.6%) had 1-3 antibiotics; 34 318 (20.2%) had 4-6 antibiotics; 30 994 (18.3%) had 7-10; 35 018 (20.6%) had 11-20; and 15 117 (8.9%) children had more than 20 antibiotic prescriptions. Overall, the population had a median total of 6 antibiotic prescriptions during the study period, but use was higher in certain patient groups: younger age (8 antibiotic fills over the 6-year period, [IQR 4-14]), White children (7 [IQR 3-13], compared to 3 [IQR 1-6] in Black children), rural settings (9 [IQR 4-15]) and chronic conditions (8 [IQR 4-15]). Higher-use groups also had lower rates of amoxicillin fills, reported as amoxicillin indices.
Conclusions:
Antibiotic use is common among most children insured by Kentucky Medicaid. A number of fills over time were higher in younger children, and in White children, children living in rural settings and children with chronic conditions. Patients with higher recurrent antibiotic use are important targets for designing high-impact antibiotic stewardship efforts.
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