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Cumulative Antibiotic Exposure in Children With Spina Bifida
Than S Kyaw1,2, Debbie Goldberg3,4, Isabel E Allen4
1Department of Urology, Massachusetts General Brigham, Boston, Massachusetts.
The Journal of Urology
|March 23, 2026
Summary
Pediatric patients with spina bifida (SB) experience significantly higher antibiotic exposure, mainly due to prolonged treatment for genitourinary (GU) infections. This highlights a critical area for managing chronic conditions in children.
Area of Science:
- Pediatric Health
- Infectious Diseases
- Pharmacology
Background:
- Spina bifida (SB) is a common congenital condition often requiring frequent antibiotic use.
- Cumulative antibiotic exposure in pediatric SB patients is not well understood.
- Genitourinary (GU) infections are a significant concern in SB management.
Purpose of the Study:
- To quantify and compare cumulative antibiotic exposure in pediatric SB patients versus controls.
- To analyze diagnoses associated with antibiotic prescriptions in SB patients.
- To identify differences in antibiotic prescribing patterns, focusing on GU infections.
Main Methods:
- Retrospective cohort study using MarketScan Commercial Claims data (2013-2021).
- Compared 13,782 SB patients (ages 0-17) with 60,301 age-matched controls (3:1 ratio).
- Analyzed antibiotic prescriptions, linked diagnoses by organ system, and prescribing trends.
Main Results:
- SB patients received 1.4 times more antibiotic prescriptions (8.2 vs. 6.0) and significantly more days of exposure (125 vs. 69).
- SB patients had higher treatment rates for GU (32% vs. 8%), GI (15% vs. 7%), and neurological infections (5.4% vs. 0.2%).
- Prolonged antibiotic courses, including prophylactic regimens, were noted for GU care in SB patients.
Conclusions:
- Pediatric SB patients exhibit substantially higher cumulative antibiotic exposure compared to controls.
- This increased exposure is primarily driven by the management of genitourinary (GU) conditions.
- Further research is needed to evaluate the patterns and necessity of prolonged antibiotic regimens in SB care.
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