US Emergency Department Visits for Adverse Drug Events From Antibiotics in Children, 2011–2015

emergency

The following is the abstract to a recently published (August 23) in The Journal of the Pediatric Infectious Society  The lead author was Maribeth Lovegove. She and other collaborators are affiliated with the Center for Disease Control and Prevention (CDC).

Abstract

Background

Antibiotics are among the most commonly prescribed medications for children; however, at least one-third of pediatric antibiotic prescriptions are unnecessary. National data on short-term antibiotic-related harms could inform efforts to reduce overprescribing and to supplement interventions that focus on the long-term benefits of reducing antibiotic resistance.

 

Methods

Frequencies and rates of emergency department (ED) visits for antibiotic adverse drug events (ADEs) in children were estimated using adverse event data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project and retail pharmacy dispensing data from QuintilesIMS (2011–2015).

Results

On the basis of 6542 surveillance cases, an estimated 69464 ED visits (95% confidence interval, 53488–85441) were made annually for antibiotic ADEs among children aged ≤19 years from 2011 to 2015, which accounts for 46.2% of ED visits for ADEs that results from systemic medication. Two-fifths (40.7%) of ED visits for antibiotic ADEs involved a child aged ≤2 years, and 86.1% involved an allergic reaction. Amoxicillin was the most commonly implicated antibiotic among children aged ≤9 years. When we accounted for dispensed prescriptions, the rates of ED visits for antibiotic ADEs declined with increasing age for all antibiotics except sulfamethoxazole-trimethoprim. Amoxicillin had the highest rate of ED visits for antibiotic ADEs among children aged ≤2 years, whereas sulfamethoxazole-trimethoprim resulted in the highest rate among children aged 10 to 19 years (29.9 and 24.2 ED visits per 10000 dispensed prescriptions, respectively).

Conclusions

Antibiotic ADEs lead to many ED visits, particularly among young children. Communicating the risks of antibiotic ADEs could help reduce unnecessary prescribing. Prevention efforts could target pediatric patients who are at the greatest risk of harm.

The introduction to the article may provide the reader with background information as to the article. It reads as follows:

Antibiotics are among the most commonly prescribed medications for children in the United States [1]. In 2011, 889 antibiotic prescriptions were dispensed from retail pharmacies for every 1000 children aged ≤19 years, which accounts for nearly 74 million prescriptions [2]. Antibiotic use drives the development of antibiotic resistance, which is considered a major public health threat worldwide [3]. Antibiotic use also carries the risk of harming individual patients. Antibiotic-related harms (which range from mild gastrointestinal disturbance to life-threatening anaphylactic reaction) are a common cause of outpatient clinic visits and are the leading cause of emergency department (ED) visits for adverse drug events (ADEs) among children in the United States [4–6].

Recent efforts to reduce antibiotic resistance have focused largely on reducing inappropriate prescribing [7–9], and national clinical guidelines have been updated accordingly [10–12]. Although clinicians generally concur and are familiar with guideline recommendations [13], national data from 2010–2011 indicate that at least 29% of outpatient pediatric antibiotic prescriptions were unnecessary, and more were likely inappropriate in antibiotic selection, dosing, or duration of therapy [14]. Continued inappropriate prescribing has been attributed to factors such as perceived parent/caregiver expectation for antibiotics and concern for parent/patient satisfaction [13, 15, 16]. Long-term societal risks of antibiotic resistance in the community are also not prioritized in clinicians’ prescribing decisions or in parent/patient considerations about treatment [13, 17–19]. Data on the short-term individual risks of antibiotic ADEs could help clinicians, as well as parents/caregivers, weigh the risks and benefits of antibiotic treatment [20, 21].

We used nationally representative public health surveillance data to identify (1) the antibiotics that result in the highest frequencies and rates of ED visits for ADEs and (2) the pediatric patients at the highest risk to help inform and target prevention efforts.

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