Advertising Disclaimer

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Finkelstein, J. A.
Right arrow Articles by Platt, R.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Finkelstein, J. A.
Right arrow Articles by Platt, R.
Related Collections
Right arrow Infectious Disease & Immunity
Social Bookmarking
 Add to CiteULike   Add to Connotea   Add to Delicious   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?
PEDIATRICS Vol. 112 No. 3 September 2003, pp. 620-627

Reduction in Antibiotic Use Among US Children, 1996–2000

Jonathan A. Finkelstein, MD, MPH*,{ddagger},§, Christopher Stille, MD, MPH*,||, James Nordin, MD, MPH*, Robert Davis, MD, MPH*,#, Marsha A. Raebel, PharmD*,**, Douglas Roblin, PhD*,{ddagger}{ddagger}, Alan S. Go, MD*,§§, David Smith, PhD*,||||, Christine C. Johnson, PhD*,¶¶, Kenneth Kleinman, ScD*,{ddagger}, K. Arnold Chan, MD, ScD*,##,***, Richard Platt, MS, MD*,{ddagger},##

* HMO Research Network Centers for Education and Research on Therapeutics
{ddagger} Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
§ Division of General Pediatrics, Children’s Hospital Boston, Boston Massachusetts
|| Meyers Primary Care Institute and Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
HealthPartners Research Foundation, Minneapolis, Minnesota
# Group Health Cooperative and Departments of Pediatrics and Epidemiology, Schools of Medicine and Public Health, University of Washington, Seattle, Washington
** Clinical Research Unit, Kaiser Permanente of Colorado, Denver, Colorado
{ddagger}{ddagger} Kaiser Permanente Georgia Region, Atlanta, Georgia
§§ Division of Research, Kaiser Permanente Northern California, Oakland, California
|||| Kaiser Permanente Center for Health Research, Portland, Oregon
¶¶ Henry Ford Health System, Detroit, Michigan
## Channing Laboratories, Brigham and Women’s Hospital, Boston, Massachusetts
*** Harvard School of Public Health, Boston, Massachusetts

Background. High rates of antibiotic prescribing to children contribute to antibiotic resistance in the community. The Centers for Disease Control and Prevention, in collaboration with other national and state level organizations, have actively promoted more judicious prescribing for children.

Objective. We sought to assess changes in the rate of antibiotic prescribing from 1996–2000 in 9 US health plans, patterns of diagnosis and treatment responsible for these trends, and changes in the use of first-line antimicrobial agents.

Design/Methods. We analyzed claims data for dispensed medications and physician visits from 9 health plans. Each provided data on 25 000 children aged 3 months to <18 years enrolled between September 1, 1995, and August 31, 2000. Antibiotic dispensings were linked with an ambulatory visit claim to assign diagnosis. Antibiotic dispensings per person-year (antibiotics/p-y) were calculated for the age groups 3 months to <3 years, 3 years to <6 years, and 6 years to <18 years. The contribution of each diagnosis to changes in the overall rate of antibiotic use was determined. Generalized linear mixed models were used to test for trend and assess differences in rates by site.

Results. From 1996–2000, antibiotic rates for children 3 months to <3 years decreased from 2.46 to 1.89 antibiotics/p-y (24%); for children 3 years to <6 years from 1.47 to 1.09 antibiotics/p-y (25%); and for children 6 to <18 years from 0.85 to 0.69 antibiotics/p-y (16%). The reduction varied among health plans from 6% to 39% for children 3 months to <3 years. A decrease in prescriptions for otitis media accounted for 59% of the total decrease, and was primarily accounted for by a decrease in the rate of diagnosis of this condition. The proportion of first-line penicillins increased from 49% to 53%, with health plans with the lowest initial rates increasing most.

Conclusions. Antibiotic prescribing decreased significantly between 1996 and 2000, concurrent with decreased frequency of diagnosis of potential bacterial infections, especially otitis media. Attention by public health and professional organizations and the news media to antibiotic resistance may have contributed to changes in diagnostic thresholds, resulting in more judicious prescribing.


Key Words: antibiotics • otitis media • upper respiratory infection

Abbreviations: CDC, Centers for Disease Control and Prevention • URI, upper respiratory infection • NAMCS, National Ambulatory Medical Care Survey • HMO, Health Maintenance Organization • CERTs, Centers for Education and Research on Therapeutics • NDC, National Drug Code • ICD-9, International Classification of Diseases, Ninth Revision • OME, otitis media with effusion • p-y, person-years


Received for publication ; Accepted May 27, 2003.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Delicious Delicious   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
Arch Pediatr Adolesc MedHome page
L. A. Prosser, M. I. Meltzer, A. Fiore, S. Epperson, C. B. Bridges, V. Hinrichsen, and T. A. Lieu
Effects of Adverse Events on the Projected Population Benefits and Cost-effectiveness of Using Live Attenuated Influenza Vaccine in Children Aged 6 Months to 4 Years
Arch Pediatr Adolesc Med, February 1, 2011; 165(2): 112 - 118.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
C. S. Broussard, K. J. Goodman, Z. Z. Nurgalieva, L. A. Fischbach, and B. D. Gold
Exposure to Antibiotics in a United States-Mexico Border Birth Cohort
Pediatrics, June 1, 2010; 125(6): e1468 - e1474.
[Abstract] [Full Text] [PDF]


Home page
CLIN PEDIATRHome page
S. A. Lorch, K. C. Wade, S. Bakewell-Sachs, B. Medoff-Cooper, J. H. Silber, and G. J. Escobar
Antibiotic Use in Premature Infants After Discharge From the Neonatal Intensive Care Unit
Clinical Pediatrics, March 1, 2010; 49(3): 249 - 257.
[Abstract] [PDF]


Home page
JAMAHome page
C. G. Grijalva, J. P. Nuorti, and M. R. Griffin
Antibiotic Prescription Rates for Acute Respiratory Tract Infections in US Ambulatory Settings
JAMA, August 19, 2009; 302(7): 758 - 766.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
M. A. O'Brien, L. A. Prosser, J. L. Paradise, G. T. Ray, M. Kulldorff, M. Kurs-Lasky, V. L. Hinrichsen, J. Mehta, D. K. Colborn, and T. A. Lieu
New Vaccines Against Otitis Media: Projected Benefits and Cost-effectiveness
Pediatrics, June 1, 2009; 123(6): 1452 - 1463.
[Abstract] [Full Text] [PDF]


Home page
CLIN PEDIATRHome page
J. R. Casey and M. E. Pichichero
A Comparison of 2 White Blood Cell Count Devices to Aid Judicious Antibiotic Prescribing
Clinical Pediatrics, April 1, 2009; 48(3): 291 - 294.
[Abstract] [PDF]


Home page
J Antimicrob ChemotherHome page
P. Davey, M. Ferech, F. Ansari, A. Muller, H. Goossens, and on behalf of the ESAC Project Group
Outpatient antibiotic use in the four administrations of the UK: cross-sectional and longitudinal analysis
J. Antimicrob. Chemother., December 1, 2008; 62(6): 1441 - 1447.
[Abstract] [Full Text] [PDF]


Home page
Ann Fam MedHome page
C. J. Stille, S. L. Rifas-Shiman, K. Kleinman, J. B. Kotch, and J. A. Finkelstein
Physician Responses to a Community-Level Trial Promoting Judicious Antibiotic Use
Ann. Fam. Med, May 1, 2008; 6(3): 206 - 212.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
S. B. Meropol
Valuing Reduced Antibiotic Use for Pediatric Acute Otitis Media
Pediatrics, April 1, 2008; 121(4): 669 - 673.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
C. M. Sox, J. A. Finkelstein, R. Yin, K. Kleinman, and T. A. Lieu
Trends in Otitis Media Treatment Failure and Relapse
Pediatrics, April 1, 2008; 121(4): 674 - 679.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
J. A. Finkelstein, S. S. Huang, K. Kleinman, S. L. Rifas-Shiman, C. J. Stille, J. Daniel, N. Schiff, R. Steingard, S. B. Soumerai, D. Ross-Degnan, et al.
Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts
Pediatrics, January 1, 2008; 121(1): e15 - e23.
[Abstract] [Full Text] [PDF]


Home page
J Antimicrob ChemotherHome page
M. Sharland and on behalf of the SACAR Paediatric Subgroup
The use of antibacterials in children: a report of the Specialist Advisory Committee on Antimicrobial Resistance (SACAR) Paediatric Subgroup
J. Antimicrob. Chemother., August 1, 2007; 60(suppl_1): i15 - i26.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
L. Vernacchio, R. M. Vezina, and A. A. Mitchell
Management of Acute Otitis Media by Primary Care Physicians: Trends Since the Release of the 2004 American Academy of Pediatrics/American Academy of Family Physicians Clinical Practice Guideline
Pediatrics, August 1, 2007; 120(2): 281 - 287.
[Abstract] [Full Text] [PDF]


Home page
Clinical Infectious DiseasesHome page
H. Goossens, M. Ferech, S. Coenen, P. Stephens, and European Surveillance of Antimicrobial Consumption
Comparison of Outpatient Systemic Antibacterial Use in 2004 in the United States and 27 European Countries
Clinical Infectious Diseases, April 15, 2007; 44(8): 1091 - 1095.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
S. S. Huang, S. L. Rifas-Shiman, K. Kleinman, J. Kotch, N. Schiff, C. J. Stille, R. Steingard, and J. A. Finkelstein
Parental Knowledge About Antibiotic Use: Results of a Cluster-Randomized, Multicommunity Intervention
Pediatrics, April 1, 2007; 119(4): 698 - 706.
[Abstract] [Full Text] [PDF]


Home page
The Annals of PharmacotherapyHome page
F. Marra, D. L Monnet, D. M Patrick, M. Chong, C. T Brandt, M. Winters, M. S Kaltoft, G. J Tyrrell, M. Lovgren, and W. R Bowie
A Comparison of Antibiotic Use in Children Between Canada and Denmark
Ann. Pharmacother., April 1, 2007; 41(4): 659 - 666.
[Abstract] [Full Text] [PDF]


Home page
J Antimicrob ChemotherHome page
F. Marra, D. M. Patrick, M. Chong, and W. R. Bowie
Antibiotic use among children in British Columbia, Canada
J. Antimicrob. Chemother., October 1, 2006; 58(4): 830 - 839.
[Abstract] [Full Text] [PDF]


Home page
Arch Pediatr Adolesc MedHome page
R. Mangione-Smith, M. N. Elliott, T. Stivers, L. L. McDonald, and J. Heritage
Ruling out the need for antibiotics: are we sending the right message?
Arch Pediatr Adolesc Med, September 1, 2006; 160(9): 945 - 952.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
C. G. Grijalva, K. A. Poehling, J. P. Nuorti, Y. Zhu, S. W. Martin, K. M. Edwards, and M. R. Griffin
National Impact of Universal Childhood Immunization With Pneumococcal Conjugate Vaccine on Outpatient Medical Care Visits in the United States
Pediatrics, September 1, 2006; 118(3): 865 - 873.
[Abstract] [Full Text] [PDF]


Home page
JRSMHome page
A. G Mainous III, S. Saxena, W. J Hueston, C. J Everett, and A. Majeed
Ambulatory antibiotic prescribing for acute bronchitis and cough and hospital admissions for respiratory infections: time trends analysis
J R Soc Med, July 1, 2006; 99(7): 358 - 362.
[Abstract] [Full Text] [PDF]


Home page
CLIN PEDIATRHome page
R. M. Siegel, J. Bien, P. Lichtenstein, J. Davis, J. C. Khoury, J. E. Knight, M. Kiely, and J. Bernier
A Safety-Net Antibiotic Prescription for Otitis Media: The Effects of a PBRN Study on Patients and Practitioners
Clinical Pediatrics, July 1, 2006; 45(6): 518 - 524.
[Abstract] [PDF]


Home page
PediatricsHome page
A. I.O. Plasschaert, M. M. Rovers, A. G. M. Schilder, T. J. M. Verheij, and E. Hak
Trends in doctor consultations, antibiotic prescription, and specialist referrals for otitis media in children: 1995-2003.
Pediatrics, June 1, 2006; 117(6): 1879 - 1886.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
J. Garbutt, I. Rosenbloom, J. Wu, and G. A. Storch
Empiric first-line antibiotic treatment of acute otitis in the era of the heptavalent pneumococcal conjugate vaccine.
Pediatrics, June 1, 2006; 117(6): e1087 - e1094.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
A. L. Kozyrskyj, M. E. Dahl, W. J. Ungar, A. B. Becker, and B. J. Law
Antibiotic treatment of wheezing in children with asthma: what is the practice?
Pediatrics, June 1, 2006; 117(6): e1104 - e1110.
[Abstract] [Full Text] [PDF]


Home page
Psychiatr. Serv.Home page
C. P. Thomas, P. Conrad, R. Casler, and E. Goodman
Trends in the Use of Psychotropic Medications Among Adolescents, 1994 to 2001
Psychiatr Serv, January 1, 2006; 57(1): 63 - 69.
[Abstract] [Full Text] [PDF]


Home page
Arch Pediatr Adolesc MedHome page
A. Coco and A. G. Mainous
Relation of Time Spent in an Encounter With the Use of Antibiotics in Pediatric Office Visits for Viral Respiratory Infections
Arch Pediatr Adolesc Med, December 1, 2005; 159(12): 1145 - 1149.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
D. Merenstein, M. Diener-West, A. Krist, M. Pinneger, and L. A. Cooper
An Assessment of the Shared-Decision Model in Parents of Children With Acute Otitis Media
Pediatrics, December 1, 2005; 116(6): 1267 - 1275.
[Abstract] [Full Text] [PDF]


Home page
JAMAHome page
M. H. Samore, K. Bateman, S. C. Alder, E. Hannah, S. Donnelly, G. J. Stoddard, B. Haddadin, M. A. Rubin, J. Williamson, B. Stults, et al.
Clinical Decision Support and Appropriateness of Antimicrobial Prescribing: A Randomized Trial
JAMA, November 9, 2005; 294(18): 2305 - 2314.
[Abstract] [Full Text] [PDF]


Home page
J Antimicrob ChemotherHome page
Y. Razon, S. Ashkenazi, A. Cohen, E. Hering, S. Amzel, H. Babilsky, A. Bahir, E. Gazala, and I. Levy
Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study
J. Antimicrob. Chemother., November 1, 2005; 56(5): 937 - 940.
[Abstract] [Full Text] [PDF]


Home page
Health Policy PlanHome page
S. Park, S. B Soumerai, A. S Adams, J. A Finkelstein, S. Jang, and D. Ross-Degnan
Antibiotic use following a Korean national policy to prohibit medication dispensing by physicians
Health Policy Plan., September 1, 2005; 20(5): 302 - 309.
[Abstract] [Full Text] [PDF]


Home page
Clinical Infectious DiseasesHome page
C. D. Marchant
Gatifloxacin Therapy for Children: An Antibiotic Still in the "Back Room"
Clinical Infectious Diseases, August 15, 2005; 41(4): 479 - 480.
[Full Text] [PDF]


Home page
Arch Pediatr Adolesc MedHome page
R. Mangione-Smith, L. Wong, M. N. Elliott, L. McDonald, and J. Roski
Measuring the Quality of Antibiotic Prescribing for Upper Respiratory Infections and Bronchitis in 5 US Health Plans
Arch Pediatr Adolesc Med, August 1, 2005; 159(8): 751 - 757.
[Abstract] [Full Text] [PDF]


Home page
Clinical Infectious DiseasesHome page
G. V. Doern, S. S. Richter, A. Miller, N. Miller, C. Rice, K. Heilmann, and S. Beekmann
Antimicrobial Resistance among Streptococcus pneumoniae in the United States: Have We Begun to Turn the Corner on Resistance to Certain Antimicrobial Classes?
Clinical Infectious Diseases, July 15, 2005; 41(2): 139 - 148.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
J. A. Finkelstein, C. J. Stille, S. L. Rifas-Shiman, and D. Goldmann
Watchful Waiting for Acute Otitis Media: Are Parents and Physicians Ready?
Pediatrics, June 1, 2005; 115(6): 1466 - 1473.
[Abstract] [Full Text] [PDF]


Home page
The Annals of PharmacotherapyHome page
M. A Raebel
Interventions to Improve Treatment of Respiratory Infections in Ambulatory Managed-Care Patients
Ann. Pharmacother., April 1, 2005; 39(4): 699 - 705.
[Abstract] [Full Text] [PDF]


Home page
Clinical Infectious DiseasesHome page
M. A. Rubin, K. Bateman, S. Alder, S. Donnelly, G. J. Stoddard, and M. H. Samore
A Multifaceted Intervention to Improve Antimicrobial Prescribing for Upper Respiratory Tract Infections in a Small Rural Community
Clinical Infectious Diseases, February 15, 2005; 40(4): 546 - 553.
[Abstract] [Full Text] [PDF]


Home page
Health Aff (Millwood)Home page
D. Atkins, J. Siegel, and J. Slutsky
Making Policy When The Evidence Is In Dispute
Health Aff., January 1, 2005; 24(1): 102 - 113.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
C. J. Stille, S. E. Andrade, S. S. Huang, J. Nordin, M. A. Raebel, A. S. Go, K. A. Chan, and J. A. Finkelstein
Increased Use of Second-Generation Macrolide Antibiotics for Children in Nine Health Plans in the United States
Pediatrics, November 1, 2004; 114(5): 1206 - 1211.
[Abstract] [Full Text] [PDF]


Home page
CMAJHome page
A. L. Kozyrskyj, A. G. Carrie, G. B. Mazowita, L. M. Lix, T. P. Klassen, and B. J. Law
Decrease in antibiotic use among children in the 1990s: not all antibiotics, not all children
Can. Med. Assoc. J., July 20, 2004; 171(2): 133 - 138.
[Abstract] [Full Text] [PDF]


Home page
Am J EpidemiolHome page
S. S. Huang, J. A. Finkelstein, S. L. Rifas-Shiman, K. Kleinman, and R. Platt
Community-Level Predictors of Pneumococcal Carriage and Resistance in Young Children
Am. J. Epidemiol., April 1, 2004; 159(7): 645 - 654.
[Abstract] [Full Text] [PDF]


Home page
Arch Pediatr Adolesc MedHome page
M. D. Dowd and V. Sharma
Questioning Dogma: Is This Test Needed?
Arch Pediatr Adolesc Med, December 1, 2003; 157(12): 1157 - 1158.
[Full Text] [PDF]


Home page
BMJHome page
In brief
BMJ, September 13, 2003; 327(7415): 578 - 578.
[Full Text] [PDF]