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Posted on 12.15.03
CERTs Study Finds Pediatric Antibiotic Use Declining
By Mike Upchurch
A recent study from the HMO Research Network CERTs is providing some encouraging news in the fight against antibiotic resistance. According to an analysis of over 225,000 pediatric patients, antibiotic prescriptions for the most common illnesses are dropping, and incorrect prescriptions for viral infections are also falling.
Antibiotic resistance has been considered a public health crisis for nearly a decade. As more and more antibiotics are prescribed, many to children, increasing numbers of bacteria that survive treatment reproduce, creating resistant strains that are difficult to treat. Because children are the most frequent recipients of antibiotic prescriptions, the federal Centers for Disease Control and Prevention (CDC) has conducted physician awareness campaigns since 1998 to encourage more judicious use of the drugs for pediatric patients.
The HMO Research Network CERTs used its access to a large patient population treated by several managed-care organizations to analyze recent trends in antibiotic use among children. Network investigators, led by HMO CERTs investigator Dr. Jonathan Finkelstein, collected data on 25,000 children from each of 9 health plans.
The team published their findings in the September issue of the journal Pediatrics. Dr. Jonathan Finkelstein was lead author of the report.
The investigators used insurance claims data from 1996 to 2000 to match up antibiotic prescriptions with each patient’s diagnosis. They divided patients into 1 of 3 age groups: 3 months to 3 years, 3 years to 6 years, and 6 years to 17 years.
The youngest age group are the most frequent users of antibiotics. Over the 5-year study period, annual prescriptions for children 3-months to 3 years old fell by 24%.
Likewise, average annual prescriptions for the other age groups fell as well. For children aged 3-6 years, prescriptions dropped to just over 1 per year per patient, a 25% reduction. In the oldest age group, average annual prescriptions fell by 16%.
The most common diagnosis prompting an antibiotic prescription for children is otitis media, the middle ear infection familiar to nearly every parent. Dr. Finkelstein and his colleagues found that a drop in prescriptions for this indication accounted for 59% of the overall reduction.
The authors speculate that, in addition to the success of the CDC’s information campaign, this may also be due to doctors recognizing the problem of antibiotic resistance through other sources and raising the “diagnostic threshold” for otitis media. More severe signs of infection may have to appear before a doctor will make the diagnosis of otitis media and thus prescribe the recommended antibiotics.
Some experts say that an increase in physicians taking a “wait and watch” approach with this infection rather than immediately prescribing antibiotics is the reason behind the drop in prescriptions. The HMO Network CERTs study, however, shows that once a diagnosis of otitis media or one of the other most common infections is made, physicians are still prescribing antibiotics for them at the same rate. This argues further for the authors’ hypothesis of rising diagnostic thresholds.
The authors stress that, with the drop in antibiotic prescriptions, comes a responsibility to monitor public health even more closely. They point out that close analysis of the prevalence of the most common infectious bacteria, such as the one that causes pneumonia and other infections, will be necessary to gauge just how well reduced prescribing is working.
The other side of the risk/benefit balance is keeping a close eye on rare but severe complications of bacterial infections that do warrant antibiotics. As diagnostic thresholds rise, the risk of these infections progressing without antibiotic treatment may increase.
The HMO Research Network CERTs analysis demonstrates the strengths of the Network’s research and operational model. With access to millions of patients treated by a variety of health plans, the HMO Research Network CERTs can design and conduct studies whose results represent a “real world” picture of how healthcare is provided and how it affects patients.
Joining Dr. Finkelstein were Dr. Richard Platt, Principal Investigator of the HMO Research Network CERT and their colleagues: Christopher Stille, MD, MPH; James Nordin, MD, MPH; Robert Davis, MD, MPH; Marsha Raebel, PharmD; Douglas Robin, PhD; Alan Go, MD; David Smith, PhD; Christine Johnson, PhD; Kenneth Kleinman, ScD; and Arnold Chan, MD, ScD.