Antimicrobial Use in Defined Populations of Infants and Young Children
Open Access
- 1 April 2000
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Pediatrics & Adolescent Medicine
- Vol. 154 (4) , 395-400
- https://doi.org/10.1001/archpedi.154.4.395
Abstract
Background Antimicrobial overprescribing contributes to bacterial resistance, but data on use in infants and young children are limited. Objectives To assess antimicrobial use in a defined population of infants and young children and to determine diagnosis-specific prescribing rates for common infections. Design and Setting Retrospective cohort study of children served by 44 practices affiliated with 2 managed care organizations. Patients Children aged 3 months to 72 months enrolled in either health plan between September 1, 1994, and August 31, 1996. Analysis Rates of antimicrobial use were calculated as the number of pharmacy dispensings divided by the number of person-years of observation contributed to the cohort in 2 age groups (3 to <36 months and 36 to <72 months). Other outcomes included the distribution of diagnoses associated with antimicrobial dispensing and population-based rates of diagnosis of common acute respiratory tract illnesses. Results A total of 46,477 children contributed 59 710 person-years of observation across the 2 health plans. Rates of antimicrobial dispensing for children aged 3 to 36 months were 3.2 and 2.1 dispensings per person-year in the 2 populations. A substantial fraction of younger children (35% in population A and 23% in population B) received 4 or more antimicrobial prescriptions in a single year. For children aged 36 to 72 months, the dispensing rates for the 2 populations were 2.0 and 1.5 antimicrobials per person-year. We found significant differences in rates between the populations studied and a decrease in use at all sites from 1995 to 1996. The diagnosis of otitis media accounted for 56% of antimicrobial drugs dispensed to children aged 3 to 36 months and 40% of those dispensed to children aged 36 to 72 months. Antimicrobial prescribing for colds and upper respiratory tract infections, bronchitis, and sinusitis was less frequent than previously reported but accounted for 10% to 14% of antimicrobial drugs dispensed. Conclusions In these populations, otitis media accounted for the largest number of antimicrobial agents dispensed to children younger than 6 years. Clearly inappropriate indications such as cold, upper respiratory tract infection, and bronchitis accounted for smaller fractions of antimicrobial use but may be most amenable to change. However, interventions that encourage use of strict criteria for diagnosis and treatment of otitis media will likely have the greatest impact on overall antimicrobial exposure. Monitoring defined populations longitudinally will allow assessment of the effectiveness of such national and local initiatives.Keywords
This publication has 13 references indexed in Scilit:
- Parents, Physicians, and Antibiotic UsePediatrics, 1999
- Otitis Media-related Antibiotic Prescribing Patterns, Outcomes, and Expenditures in a Pediatric Medicaid PopulationPublished by American Academy of Pediatrics (AAP) ,1997
- Minimizing the impact of drug-resistant Streptococcus pneumoniae (DRSP). A strategy from the DRSP Working GroupPublished by American Medical Association (AMA) ,1996
- The Prevalence of Drug-ResistantStreptococcus pneumoniaeIn AtlantaNew England Journal of Medicine, 1995
- Penicillin-Resistant Pneumococci From Pediatric Patients in the Washington, DC, AreaArchives of Pediatrics & Adolescent Medicine, 1995
- Practice guideline for the management of infants and children 0 to 36 months of age with fever without sourceAnnals of Emergency Medicine, 1993
- The Crisis in Antibiotic ResistanceScience, 1992
- Acute otitis media: a new treatment strategy.BMJ, 1985
- Variations in Medical Care among Small AreasScientific American, 1982
- The International Classification of Diseases: Ninth Revision (ICD-9)Annals of Internal Medicine, 1978