Drug prescriptions for US children dipped by more than one-quarter in the first eight months of the pandemic, with the biggest drops in drugs used to treat infections and cold symptoms, according to a University of Michigan-led study published yesterday in Pediatrics.
While the decline mirrors downward trends seen in prescriptions for adults early in the pandemic, the numbers did not rebound for children to the same degree, the study authors said.
The researchers used the IQVIA National Prescription Audit, which tracks monthly prescriptions from 92% of US retail, mail-order, and long-term care pharmacies, to measure changes in those dispensed to children and teens 0 to 19 years old before and during the pandemic.
Specifically, they compared prescription totals from April to December 2020 with those from April to December 2019 overall, by drug class, and among classes usually used to treat infections (eg, antibiotics) or chronic diseases (eg, antidepressants).
Antibiotic Rx down 55.6%
The median number of overall monthly prescriptions for children from January 2018 to February 2020 was 25.7 million. But in March and April 2020, dispensing totals fell to 16.7 million, rose to 19.7 million in October, and dropped to 15.8 million in December.
Prescriptions for kids were down 27.1% in April to December 2020 (160.6 million) than in the same period the year before (220.3 million). Clinicians wrote 51.3% fewer prescriptions for drugs used to treat infections and 17.4% fewer for those used to treat chronic diseases.
Of three drug classes making up the most prescriptions in 2019, antibiotics plummeted 55.6%, attention-deficit hyperactivity disorder (ADHD) drugs fell 11.8%, but antidepressants declined only 0.1%.
The researchers suggested that antibiotic prescription numbers may have fallen because of children's behaviors during the pandemic. "The decrease in antibiotic dispensing most likely reflects reductions in infections, such as colds and strep throat, due to COVID-19 risk-mitigation measures like social distancing and face masks," lead author Kao-Ping Chua, MD, PhD, said in a University of Michigan news release.
"As a result, children had fewer infection-related visits and had fewer opportunities to receive antibiotic prescriptions, whether for antibiotic-appropriate conditions or antibiotic-inappropriate conditions," he said, adding that because antibiotics have side effects, the dramatic declines in prescriptions for them may be a good thing.
And if COVID-19 public health protocols continue in schools and day care facilities, potentially lowering the risk of ear, sinus, and upper respiratory infections, antibiotic prescribing may not need to increase to previous levels soon, Chua added.
Antibiotic use is the leading cause of visits to an emergency department for adverse drug events, including allergic reactions, fungal infections, and diarrhea, and may contribute to antibiotic resistance, according to the release.
Decreases in prescriptions for drugs to relieve symptoms of the common cold were another benefit of COVID mitigations, the researchers said, with a close to 80% decrease in cough suppressant prescriptions. "These drugs have little benefit but are associated with potentially harmful side effects, particularly in young children," Chua said.
Clinicians can act on results
Decreased prescriptions for chronic disease medications, however, are worrisome, according to the authors. "Decreased dispensing of chronic disease drugs to children during the pandemic is potentially concerning and warrants further investigation," they wrote.
While drops in prescriptions for asthma and ADHD drugs are potentially concerning, the researchers say the number of asthma attacks among children fell dramatically during the pandemic, and ADHD medications may not have been needed as much because of the switch to distance learning.
The decline in antidepressant prescribing, while not large, could be a good thing in terms of children not discontinuing their use, Chua said. "Studies, however, suggest that the mental health of children has worsened during the pandemic, particularly among adolescents," he noted. "Given this, our findings might suggest that antidepressant dispensing has not risen to meet this increased need."
Healthcare providers could access electronic health records to identify decreases in refill requests among kids on established drug regimens for chronic diseases and then follow up with parents to ascertain whether they can no longer afford the drugs or whether their child's condition has improved, Chua suggested.