Association of Inappropriate Outpatient Pediatric Antibiotic Prescriptions With Adverse Drug Events and Health Care Expenditures

Abstract

IMPORTANCE Nonguideline antibiotic prescribing for the treatment of pediatric infections is common, but the consequences of inappropriate antibiotics are not well described. OBJECTIVETo evaluate the comparative safety and health care expenditures of inappropriate vs appropriate oral antibiotic prescriptions for common outpatient pediatric infections. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included children aged 6 months to 17 years diagnosed with a bacterial infection (suppurative otitis media [OM], pharyngitis, sinusitis) or viral infection (influenza, viral upper respiratory infection [URI], bronchiolitis, bronchitis, nonsuppurative OM) as an outpatient from April 1, 2016, to September 30, 2018, in the IBM MarketScan Commercial Database. Data were analyzed from August to November 2021. EXPOSURES Inappropriate (ie, non-guideline-recommended) vs appropriate (ie, guideline-recommended) oral antibiotic agents dispensed from an outpatient pharmacy on the date of infection. MAIN OUTCOMES AND MEASURES Propensity score-weighted Cox proportional hazards modelswere used to estimate hazards ratios (HRs) and 95% CIs for the association between inappropriate antibiotic prescriptions and adverse drug events. Two-part models were used to calculate 30-day all-cause attributable health care expenditures by infection type. National-level annual attributable expenditures were calculated by scaling attributable expenditures in the study cohort to the national employer-sponsored insurance population. RESULTSThe cohort included 2 804 245 eligible children (52% male; median [IQR] age,[8][9][10][11][12] years). Overall, 31% to 36% received inappropriate antibiotics for bacterial infections and 4% to 70% for viral infections. Inappropriate antibiotics were associated with increased risk of several adverse drug events, including Clostridioides difficile infection and severe allergic reaction among children treated with a nonrecommended antibiotic agent for a bacterial infection (among patients with

Nasopharyngeal rapid diagnostic testing to reduce unnecessary antibiotic use and individualize management of acute otitis media

“…40 A change in guidelines that recommends first-line use of a broad-spectrum antibiotic would likely result in increased resistance, ADEs, and cost. 8,9,49 Fortunately, scientific advancement has rendered it feasible to identify the presence of organisms and resistance-associated genes quickly and reliably. A shift to an evidence-based RDT-guided therapy could reduce ambiguity around which bacterial pathogens are present, if treatment with immediate antibiotics is necessary, and reduce unnecessary costs and ADEs.…”

Antibiotic Prescription Audits Among Pediatric Outpatients With Acute Ailments in a Secondary Care Hospital During the COVID-19 Omicron Wave in Northern India

“…Irrational prescription of antibiotics is strongly linked with triggering accelerated antibiotic resistance, a phenomenon through which microorganisms induce changes in themselves that render them protection against prior antibiotic susceptibility [ 1 , 8 - 10 ]. Furthermore, there is growing recognition that inappropriate antibiotic prescription in children is linked to increasing rates of severe adverse drug events and higher medical expenditures [ 11 ]. Moreover, prescribing errors contribute to a further increase in patient morbidity and mortality [ 12 - 14 ].…”

Appropriate Antibiotic Prescribing—The Safer and Less Expensive Choice

“…Elsewhere in JAMA Network Open , Butler and colleagues used data from the 2017 IBM MarketScan database to identify ADEs and costs after inappropriate prescribing for common bacterial (suppurative otitis media, pharyngitis, and sinusitis) and viral upper respiratory tract infections in children. Their primary analysis compared outcomes among children who received guideline-discordant therapy with those who received first-line antibiotic agents (amoxicillin for otitis media; amoxicillin or penicillin for pharyngitis; and amoxicillin or amoxicillin-clavulanate for sinusitis).…”