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Updated: Aug 5, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Antibiotic Utilization in Medicaid-Enrolled Children: Associations with Medical Complexity

Kathleen D Snow1, Matthew Hall2, Jay G Berry1

  • 1Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA.

The Journal of Pediatrics
|August 3, 2026
PubMed

Insights

Pediatric antibiotic use is higher in children with complex chronic conditions (CCCs). These children may benefit from targeted antibiotic stewardship interventions to reduce exposure and broad-spectrum antibiotic use.

Area of Science:

  • Pediatric pharmacology
  • Public health
  • Infectious disease epidemiology

Background:

  • Antibiotic utilization in pediatric populations requires ongoing monitoring.
  • Understanding factors influencing antibiotic prescribing is crucial for effective stewardship.
  • Children with complex chronic conditions (CCCs) may have unique patterns of antibiotic use.

Purpose of the Study:

  • To characterize current pediatric outpatient antibiotic prescribing patterns.
  • To identify patient-specific factors linked to high antibiotic consumption.
  • To inform targeted antibiotic stewardship initiatives.

Main Methods:

  • Retrospective cohort study utilizing Medicaid prescription claims data (2023).
  • Inclusion of children aged 0-18 years with continuous Medicaid enrollment.
  • Analysis of antibiotic fill rates and high utilization (>50 antibiotic days/year) using multivariable logistic regression.

Main Results:

  • 39.1% of 2.36 million Medicaid-enrolled children filled >1 antibiotic prescription.
  • Antibiotic rates increased significantly with medical complexity, from 514 to 2,882 per 1,000 persons for no vs. ≥3 CCCs.
  • High antibiotic use was associated with younger age, female sex, disability status, capitated plans, and increasing CCCs.

Conclusions:

  • Children with multiple CCCs exhibit substantially elevated antibiotic exposure.
  • Greater use of broad-spectrum antibiotics is observed in children with higher medical complexity.
  • This population represents an underrecognized group for antibiotic stewardship interventions.
Abstract

Keywords:
antibiotic prescription ratesantibiotic stewardshipchildren with medical complexity

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