Recent trends in outpatient antibiotic use in children.
OBJECTIVE
The goal of this study was to determine changes in antibiotic-dispensing rates among children in 3 health plans located in New England [A], the Mountain West [B], and the Midwest [C] regions of the United States.


METHODS
Pharmacy and outpatient claims from September 2000 to August 2010 were used to calculate rates of antibiotic dispensing per person-year for children aged 3 months to 18 years. Differences in rates by year, diagnosis, and health plan were tested by using Poisson regression. The data were analyzed to determine whether there was a change in the rate of decline over time.


RESULTS
Antibiotic use in the 3- to <24-month age group varied at baseline according to health plan (A: 2.27, B: 1.40, C: 2.23 antibiotics per person-year; P < .001). The downward trend in antibiotic dispensing slowed, stabilized, or reversed during this 10-year period. In the 3- to <24-month age group, we observed 5.0%, 9.3%, and 7.2% annual declines early in the decade in the 3 plans, respectively. These dropped to 2.4%, 2.1%, and 0.5% annual declines by the end of the decade. Third-generation cephalosporin use for otitis media increased 1.6-, 15-, and 5.5-fold in plans A, B, and C in young children. Similar attenuation of decline in antibiotic use and increases in use of broad-spectrum agents were seen in other age groups.


CONCLUSIONS
Antibiotic dispensing for children may have reached a new plateau. Along with identifying best practices in low-prescribing areas, decreasing broad-spectrum use for particular conditions should be a continuing focus of intervention efforts.
Division of Infectious Diseases and Department of Laboratory Medicine and.
Louise Elaine
LE
Vaz
Kenneth P
KP
Kleinman
Marsha A
MA
Raebel
James D
JD
Nordin
Matthew D
MD
Lakoma
M Maya
MM
Dutta-Linn
Jonathan A
JA
Finkelstein
D000293:Adolescent; D000553:Ambulatory Care / Q000639:trends*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003625:Data Collection / Q000639:trends; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000639:trends*; D008297:Male; D015146:Midwestern United States / Q000453:epidemiology; D009511:New England / Q000453:epidemiology; D015205:Northwestern United States / Q000453:epidemiology
D000900:Anti-Bacterial Agents
antibiotics; otitis media; respiratory tract infections