A study of children enrolled in Medicaid found a high rate of outpatient antibiotic use in kids with medical complexity, researchers from Boston Children's Hospital reported late last week at the annual meeting of the Pediatric Academic Societies (PAS).
Using the multistate MarketScan Medicaid Database, the researchers examined outpatient antibiotic claims in more than 2.3 million children ages 0 to 18 years who were enrolled in Medicaid in 2023. They categorized the children into five groups—healthy; non-complex chronic condition; and one, two, and three or more complex chronic conditions (CCCs)—and compared antibiotic prescribing rates across groups.
Antibiotics are the most commonly prescribed medication in children, but little is known about antibiotic use in kids with medical complexity, who are prone to infection.
Nearly 40% filled at least 1 antibiotic prescription
Of the children included in the analysis, 39.3% filled one or more antibiotic prescriptions over the study period. Annual prescription rates per 1,000 children rose more than fivefold across the five groups as the level of medical complexity increased, rising from 514 in healthy children to 2,882 in children with three or more CCCs. Children with medical complexity were also far more likely to be prescribed broad-spectrum antibiotics. Penicillins, cephalosporins, and macrolides accounted for 93% of antibiotics prescribed to healthy children, while children with three or more CCCs had substantially more prescriptions for sulfonamides, quinolones, and aminoglycosides.
The researchers said that children with three or more CCCs have the highest annual antibiotic prescription rate of any population, pediatric or adult.
"These findings suggest that children with medical complexity may be a high-impact population for future antibiotic stewardship efforts,” lead author Kate Snow, MD, an instructor at Boston Children's, said in a PAS press release.