Less Than a Third of Pediatric Antibiotic Prescriptions Were Optimal for Choice and Duration: Study

Amid continuing efforts to address the medical community’s challenge of antibiotic overuse, which can lead to resistant “superbug” infections, new research shows that only about 30% of antibiotic prescriptions for children are the optimal treatment choice.

Superbugs have become an increasing global health threat in recent years, with bacteria and other pathogens developing resistance to existing antibiotics, making them increasingly difficult to treat.

To reduce the long-term risk of these antibiotic-resistant infections developing, health experts widely agree that doctors need to make sure antibiotic prescriptions are optimal, especially for children. This includes making sure the drugs are given for the right duration and only for infections that can be treated by the drugs, which should never include viral infections.

In a study published in the journal JAMA Network Open on October 3, researchers warn  that only 4% of antibiotic prescriptions for children were given for infections that can only be treated by the drugs. Most antibiotics were used in cases where they were not necessarily required, and one-third were rarely required to treat the condition, according to the findings.

In the new study, researchers from Vanderbilt University Medical Center, led by Dr. Brittany J. Lehrer, analyzed 506,000 antibiotic prescriptions from nearly 489,000 pediatric clinical visits in Tennessee in 2022.

They used data from IQVIA’s Longitudinal Prescription Claims and Medical Claims databases. The data included clinical visits for patients younger than 20 years old with at least one outpatient oral antibiotic, intramuscular ceftriaxone or penicillin prescription filled in 2022.

The study categorized diagnoses into three tiers. Tier 1 diagnoses nearly always required antibiotics to treat the condition, which accounted for about 4% of the prescriptions for children. Tier 2 diagnoses sometimes required antibiotics, accounting for 57% of the prescriptions. However, tier 3 diagnoses included conditions that rarely ever require antibiotics, yet researchers found 39% of prescriptions for children fit into this category.

Researchers found that only about 31% of antibiotic prescriptions for children could be considered both appropriate and for the right length of time. About 38% were appropriate, but not for the right duration, and 51% were for the right duration but not appropriate for the condition.

For example, ear infections and pharyngitis (severe sore throat) were the most common conditions treated. However, only 67% of ear infection prescriptions and 56% of pharyngitis prescriptions were considered optimal.

Lehrer’s team determined prescriptions were often given without considering the most recent evidence to support not needing antibiotics or prescribing for shorter durations. They also said appropriate antibiotic prescribing was more likely in patients who were younger and less socially vulnerable.

The study’s authors indicate that additional doctor education is needed to highlight the benefit of shorter antibiotic courses. Additionally, more antibiotic-prescribing interventions are needed to help boost appropriate prescribing. This can also help reduce the creation of antibiotic-resistant superbugs, researchers said.

Inappropriate Pediatric Antibiotic Prescriptions

According to a report published in September, antibiotic-resistant superbugs could kill nearly 40 million people by 2050 unless drastic measures are taken to reduce the misuse of antibiotics and work is done to create new antibiotic strains.

The American Academy of Pediatrics also warns that giving premature infants antibiotics in the first weeks of life increases their risk of suffering serious lung conditions. Antibiotics are often given to preemies as preventive measures instead of to treat a specific infection.

In fact, children are often given antibiotics for a number of conditions that antibiotics aren’t effective in treating, including viral conditions. The rise in inappropriate antibiotic prescribing among children has many researchers worried.