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Prescribing Patterns of Nonrecommended Medications for Children With Acute COVID-19
Julianne E Burns1, Alex Dahlen2, Laura L Bio3
1Divisions of Infectious Diseases.
Insights
Despite low rates, nonrecommended COVID-19 medications were prescribed to children, highlighting the need for clear guidance. Understanding these prescribing patterns is crucial for safeguarding children's health.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacovigilance
- Public Health Policy
Background:
- Repurposed medications for COVID-19 were prescribed despite evidence against their use.
- National guidelines discouraged the use of certain medications for acute COVID-19.
Purpose of the Study:
- To determine prescribing rates of nonrecommended medications for acute COVID-19 in children.
- To identify demographic factors and provider types associated with these prescriptions.
- To analyze prescribing trends during periods when national guidelines advised against use.
Main Methods:
- Retrospective cohort study using a large US all-payer claims database.
- Analysis of children under 18 diagnosed with COVID-19 between March 2020 and December 2022.
- Multivariable logistic regression to identify risk factors for prescription.
Main Results:
- Hydroxychloroquine (HCQ) and ivermectin were prescribed in 0.03% and 0.14% of pediatric COVID-19 cases, respectively, during nonrecommended periods.
- Prescription rates varied significantly by state, with higher rates in Arkansas (HCQ) and Oklahoma (ivermectin).
- Older age, nonpublic insurance, emergency department visits, nonurban, and low-income areas were associated with increased prescription risk; general practitioners had the highest prescribing rates.
Conclusions:
- While prescription rates were low, the high burden of COVID-19 resulted in numerous ineffective and potentially harmful prescriptions for children.
- Understanding overuse patterns is key to mitigating misinformation and its consequences.
- Disseminating clear, evidence-based recommendations to providers and parents is vital for pediatric health.
Objective:
Repurposed medications for acute coronavirus disease 2019 (COVID-19) continued to be prescribed after results from rigorous studies and national guidelines discouraged use. We aimed to describe prescribing rates of nonrecommended medications for acute COVID-19 in children, associations with demographic factors, and provider type and specialty.
Methods:
In this retrospective cohort of children <18 years in a large United States all-payer claims database, we identified prescriptions within 2 weeks of an acute COVID-19 diagnosis. We calculated prescription rate, performed multivariable logistic regression to identify risk factors, and described prescriber type and specialty during nonrecommended periods defined by national guidelines.
Results:
We identified 3 082 626 COVID-19 diagnoses in 2 949 118 children between March 7, 2020 and December 31, 2022. Hydroxychloroquine (HCQ) and ivermectin were prescribed in 0.03% and 0.14% of COVID-19 cases, respectively, during nonrecommended periods (after September 12, 2020 for HCQ and February 5, 2021 for ivermectin) with considerable variation by state. Prescription rates were 4 times the national average in Arkansas (HCQ) and Oklahoma (ivermectin). Older age, nonpublic insurance, and emergency department or urgent care visit were associated with increased risk of either prescription. Additionally, residence in nonurban and low-income areas was associated with ivermectin prescription. General practitioners had the highest rates of prescribing.
Conclusions:
Although nonrecommended medication prescription rates were low, the overall COVID-19 burden translated into high numbers of ineffective and potentially harmful prescriptions. Understanding overuse patterns can help mitigate downstream consequences of misinformation. Reaching providers and parents with clear evidence-based recommendations is crucial to children's health.
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