Association Between Rotavirus Vaccination and Antibiotic Prescribing Among Commercially Insured US Children, 2007–2018

Abstract

Background Vaccines may play a role in controlling the spread of antibiotic resistance. However, it is unknown if rotavirus vaccination affects antibiotic use in the United States (US). Methods Using data from the IBM MarketScan Commercial Database, we conducted a retrospective cohort of US children born between 2007 and 2018 who were continuously enrolled for the first 8 months of life (N = 2 136 136). We followed children through 5 years of age and compared children who completed a full rotavirus vaccination series by 8 months of age to children who had not received any doses of rotavirus vaccination. We evaluated antibiotic prescriptions associated with an acute gastroenteritis (AGE) diagnosis and defined the switching of antibiotics as the prescription of a second, different antibiotic within 28 days. Using a stratified Kaplan-Meier approach, we estimated the cumulative incidence for each study group, adjusted for receipt of pneumococcal conjugate vaccine, provider type, and urban/rural status. Results Overall, 0.8% (n = 17 318) of participants received an antibiotic prescription following an AGE diagnosis. The 5-year adjusted relative cumulative incidence of antibiotic prescription following an AGE diagnosis was 0.793 (95% confidence interval [CI], .761–.827) among children with complete rotavirus vaccination compared to children without rotavirus vaccination. Additionally, children with complete vaccination were less likely to switch antibiotics (0.808 [95% CI, .743–.887]). Rotavirus vaccination has averted an estimated 67 045 (95% CI, 53 729–80 664) antibiotic prescriptions nationally among children born between 2007 and 2018. Conclusions These results demonstrate that rotavirus vaccines reduce antibiotic prescribing for AGE, which could help reduce the growth of antibiotic resistance.

Investigating association between inflammatory bowel disease and rotavirus vaccination in a paediatric cohort in the UK

“…Antibiotic prescription for gastroenteritis is less common in this primary care research population, given viral causes will make up the majority of cases. Further attention on this subject should consider that rotavirus vaccination is shown to reduce antibiotic prescribing for AGE in primary care [33]. As such vaccination may influence IBD incidence through reductions in both infection and antibiotic prescribing.…”

Available evidence and potential for vaccines for reduction in antibiotic prescriptions

“…Two live-attenuated, oral vaccines has been introduced into the national immunization programs of several countries showing a significant impact on morbidity and mortality and an adequate tolerability and safety profile. 50 Very recently, a retrospective cohort study of US children evaluated antibiotic prescriptions associated with acute gastroenteritis (AGE) showing that prescriptions were significantly lower in children with complete vaccination against rotavirus in respect to unimmunized children. 51 Noteworthy, antibiotics in viral diseases are not effective and their prescription should be avoided unless a bacterial complication has been ruled out.…”