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Dynamics of Pediatric Antibiotic Use Differ between High- and Low-Prescribing Clinics after Pneumococcal Conjugate
Dana Danino1, Bart Adriaan van der Beek2, Noga Givon-Lavi1
1Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel.
Insights
Pneumococcal conjugate vaccines (PCV) significantly reduced antibiotic prescriptions in children under 5, particularly in high-prescribing clinics. This vaccine use helped close the gap between high and low antibiotic prescribing rates, promoting judicious antibiotic use.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Antimicrobial stewardship
Background:
- Antibiotic overuse in children contributes to resistance.
- Pneumococcal conjugate vaccines (PCV) have been implemented to reduce infections.
- Disparities exist in antibiotic prescribing rates across different clinics and ethnic groups.
Purpose of the Study:
- To compare dispensed oral antibiotic prescription rates (DAPRs) after PCV implementation.
- To analyze DAPRs in high antibiotic-prescribing clinics (HPC) versus low antibiotic-prescribing clinics (LPC).
- To assess differences in DAPRs between Jewish and Bedouin children under 5.
Main Methods:
- Retrospective analysis of clinic data from 2005-2018.
- Defined HPC and LPC based on median DAPRs for distinct ethnic groups.
- Utilized interrupted time series to analyze monthly DAPR trends and calculated incidence rate-ratios.
Main Results:
- Bedouin HPC had the highest pre-PCV DAPR, followed by Jewish HPC, Bedouin LPC, and Jewish LPC.
- DAPRs declined in all groups post-PCV, except Jewish LPC, stabilizing within 4-5 years.
- The magnitude of DAPR decline was proportional to pre-PCV rates, significantly reducing the gap between HPC and LPC.
Conclusions:
- PCVs are effective in reducing outpatient antibiotic consumption in young children.
- The impact of PCV was more pronounced in HPC, suggesting a role in promoting judicious antibiotic use.
- PCV-associated reductions in respiratory disease likely contribute to decreased antibiotic prescribing.
Objective:
To compare dispensed oral antibiotic prescription rates (DAPRs) after implementation of pneumococcal conjugate vaccine (PCV) in high antibiotic-prescribing clinics (HPC) with low antibiotic-prescribing clinics (LPC) in 2 distinct ethnic groups of children (Jewish and Bedouin children) <5 years of age.
Methods:
Clinics with ≥50 insured children, active both pre-PCV (2005-2009) and post-PCV (2010-2018) implementation, were included. HPC and LPC were defined by DAPRs above or below the median in each age and ethnic group. Monthly dispensed antibiotic prescription rate (DAPR) trends (adjusted for age and ethnicity) were calculated using interrupted time series. Mean yearly incidence rate-ratios (late PCV13 vs pre-PCV) were calculated.
Results:
Bedouin HPC had the highest pre-PCV overall-DAPR per 1000 child-years ± SD (2520.4 ± 121.2), followed by Jewish HPC (1885.5 ± 47.6), Bedouin LPC (1314.8 ± 81.6), and Jewish LPC (996.0 ± 19.6). Shortly after PCV implementation, all DAPRs and amoxicillin/amoxicillin-clavulanate DAPRs declined in all groups except Jewish LPC, stabilizing within 4-5 years post-PCV. The rates and magnitudes of declines were directly proportional to the pre-PCV DAPR magnitudes, achieving near-complete closure of the pre-PCV DAPR gaps between the 4 groups (rates during late-PCV13 ranging from 1649.4 ± 23.5 [Bedouin HPC] to 1200.3 ± 72.4 [Jewish LPC]).
Conclusions:
PCVs are a powerful tool in reducing outpatient antibiotic consumption among young children, especially in HPC, resulting in partial closure of DAPR gap between HPC and LPC. The higher impact on HPC suggests that PCV-associated declines of respiratory disease may strongly contribute to a judicious antibiotic approach in clinics with high antibiotic consumption.
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