Antibiotics continue to be the most commonly implicated drugs in children’s emergency department (ED) visits for adverse drug events (ADEs), researchers from the Centers for Disease Control and Prevention reported late last week in the Journal of the Pediatric Infectious Diseases Society.

Adverse reactions to antibiotics in kids accounted for an estimated average of 47,628 ED visits annually from 2019 through 2023, according to an analysis of data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance and corresponding US Census Bureau estimates. Antibiotic-related ADEs represented 37% all ED visits for ADEs over the study period.

Among children under age two years and ages three to four, antibiotics were implicated in 53.7% and 54.3% of ED visits for ADEs, respectively. In children ages 10 to 19, antibiotics were implicated in 21.4% of such visits. 

The vast majority of visits for antibiotic-related ADEs (86.6%) involved allergic reactions, and 3.3% resulted in hospitalization. Oral antibiotics, primarily penicillins, accounted for 98.8% of antibiotic-related ADEs.

Weighing risks and benefits

The study authors note that while the estimated average number of annual ED visits for ADEs over the study period is lower than found in an analysis of the same surveillance system from 2011 through 2015, the new findings likely reflect the impact of the COVID-19 pandemic, which contributed to declines in ED visits and antibiotic prescribing in 2020 and 2021. In 2023, the estimated number of ED visits for antibiotic-related ADEs in kids climbed to 73,095.

“Although overall antibiotic prescribing has decreased in recent years in the USA, especially among children, there remain continued opportunities for reducing harms,” they wrote. 

In an accompanying editorial, Ganga Moorthy, MD, of Duke School of Medicine and Matthew Kronman, MD, of the University of Washington say the estimates “provide useful benchmarks when considering the risks and benefits of antibiotics for possible infectious syndromes.”

“If the risk of an ADE outweighs the likelihood of the possible complication, watch-and-wait approaches for children without a clear diagnosis of a bacterial infection are prudent, and conversations with families should routinely include the risks associated with antibiotics as part of the shared decision-making process,” they wrote.