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Published on: August 30, 2018
Association between high-intensity antibiotic prescribing and prescribing of psychotropic drugs in children: a
Sarah Christina Jane Jorgensen1,2,3,4, Kevin Brown3,4,5, Anna E Clarke2,4
1Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA jorgensen.sarah@marshfieldresearch.org.
Insights
High antibiotic prescribing in children was linked to less psychotropic drug use. This suggests a need for tailored pediatric drug stewardship strategies for various medication classes.
Area of Science:
- Pediatric pharmacology
- Public health
- Health services research
Background:
- Physician prescribing patterns for antibiotics and other medications are linked in adults.
- The relationship between high antibiotic prescribing and other frequently overprescribed medications in children is not well understood.
Purpose of the Study:
- To investigate the association between high-intensity antibiotic prescribing and the prescribing of psychotropic medications (stimulants, antidepressants, antipsychotics) in a pediatric population.
- To examine how factors like continuity of care and physician payment models influence this association.
Main Methods:
- A population-based cohort study in Ontario, Canada, from 2018-2019.
- Involved child-physician pairs with at least one primary care visit.
- Used multivariable, hierarchical logistic regression to analyze prescribing patterns, adjusting for child characteristics and physician-level clustering.
Main Results:
- High antibiotic prescribers were less likely to prescribe psychotropic drugs, stimulants, and antidepressants in children (aOR 0.66, 0.67, and 0.79, respectively).
- No significant association was found between high antibiotic prescribing and antipsychotic prescribing (aOR 0.95).
- The inverse association was stronger with higher continuity of care, rostered primary care physicians, and fee-for-service payment models.
Conclusions:
- High antibiotic prescribing in children is generally associated with a lower likelihood of prescribing psychotropic medications.
- Findings highlight the need for individualized pediatric drug stewardship approaches considering different drug classes.
Background:
Studies among adults have found that physicians who are high antibiotic prescribers are also high prescribers of other medications that are frequently overprescribed or prescribed inappropriately. The extent to which these findings generalise to prescribing for paediatric populations is unknown.
Methods:
Population-based cohort study, Ontario, Canada, involving child-physician pairs with ≥1 primary care visit, 2018-2019. We used multivariable, hierarchical logistic regression to determine the association between high-intensity antibiotic prescribing and prescribing of stimulants, antidepressants, antipsychotics or all three drug classes, adjusting for child characteristics and clustering of child-physician pairs within physicians.
Results:
2 531 392 visits were included (834 565 children, 10 286 physicians). Psychotropic drug, stimulant and antidepressant prescribing was lower among high antibiotic prescribers versus average/low-intensity prescribers (adjusted OR (aOR) 0.66 (95% CI 0.62 to 0.71), 0.67 (95% CI 0.62 to 0.72) and 0.79 (95% CI 0.70 to 0.89), respectively). There was no association between the odds of a physician prescribing an antipsychotic and high-intensity antibiotic prescribing (aOR 0.95 (95% CI 0.84 to 1.08)). The inverse association between prescribing of psychotropic drugs and high-intensity antibiotic prescribing was stronger for visits with children with high continuity of care versus average/low continuity of care (aOR 0.42 (95% CI 0.34 to 0.52) vs aOR 0.72 (95% CI 0.66 to 78)), visits with children's rostered versus non-rostered primary care physicians (aOR 0.54 (95% CI 0.48 to 0.59) vs aOR 0.74 (95% CI 0.68 to 0.81)) and visits with physicians remunerated under a fee-for-service versus salaried/capitation-based models (aOR 0.63 (95% CI 0.56 to 0.70) vs aOR 0.86 (95% CI 0.77 to 0.97)).
Conclusions:
High antibiotic prescribing was generally associated with a lower propensity to prescribe psychotropic drugs among children. Our findings suggest the need for tailored approaches to paediatric drug stewardship across different classes of drugs.
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