Inappropriate antibiotic prescriptions for children

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According to a recent cohort study involving children with common outpatient infections, inappropriate antibiotic prescriptions were frequent and were associated with an increased risk of adverse drug events and higher attributable healthcare costs. The article The association of inappropriate outpatient pediatric antibiotic prescriptions with adverse drug events and healthcare costs Was published in JAMA Network Open and highlights the individual and national implications of inappropriate antibiotic treatment, further supporting the implementation of outpatient administration programs for this class of drugs.

Also read: Diarrhea associated with the use of antibiotics

Inappropriate antibiotic prescriptions for children


The purpose of the study was to assess the comparative safety and health costs of inappropriate oral antibiotic prescriptions. against suitable for common outpatient pediatric infections.

The researchers conducted a cohort study that included pediatric patients aged 6 months to 17 years diagnosed with:

  • Bacterial infection – suppurative otitis media (OM), pharyngitis and sinusitis; or
  • Viral infection – influenza, upper respiratory tract infection (URI), bronchiolitis, asthma and non-suppurative OM.

Data were collected from April 1, 2016 to September 30, 2018 and analyzed from August to November 2021 using the US commercial database. IBM MarketScan (2015-2018), which contains longitudinal patient data on treated hospital and outpatient insurance registrations and injuries as well as medication dispensed in an outpatient pharmacy for persons with business insurance, primarily sponsored by the employer and their spouses and relatives.


2,804,245 qualified pediatric patients were included. The median age of the patients was 8 years and 52% were men.

Overall, 31% to 36% of participants received inappropriate antibiotics for bacterial infections and 4% to 70% for viral infections.

For children with bacterial infections, inappropriate antibiotic prescriptions were generally associated with an increased risk of bacterial infection. Clostridioides difficult (ICD) (among children with suppurative OM or pharyngitis, the risk of CDI was increased by more than six and eight times, respectively); diarrhea no C. difficult (eg in children with suppurative OM, the risk was increased by 1.3-fold); and nausea, vomiting or abdominal pain as well as unspecified allergy. For children with viral infections, inappropriate antibiotic prescriptions were associated with an increased risk of rash or hives as well as unspecified allergy to viral URIs and non-suppurative OM.

Attributable 30-day health care costs were generally higher among children receiving inappropriate antibiotics, ranging from $ 21 to $ 56 for bacterial infections and $ 96 to $ 97 for viral infections. Estimates of national annual attributable expenses were highest for suppurative OM (US $ 25.3 million), pharyngitis (US $ 21.3 million) and viral URI (US $ 19.1 million).

In summary, in this study, which included more than 2.8 million commercially insured children, inappropriate antibiotics were associated with an increased risk of several adverse drug events, such as DHF and severe allergic reaction, and generally higher costs attributable to all causes after 30 days. . Estimates of annual expenses in the United States associated with inappropriate antibiotic treatment in the insured pediatric population were higher for suppurative OM, pharyngitis, and viral upper respiratory tract infection.


The study reflects an American reality and highlights the negative health and economic consequences associated with inappropriate antibiotic prescriptions for the treatment of common bacterial and viral infections in childhood. The researchers emphasize that these findings are essential to inform healthcare professionals’ decisions, including patient groups, public and private payers, and healthcare administrators, to implement widespread antimicrobial management activities in outpatient settings to reduce antibiotic-related harm and costs. .

Find out more: UTI in infants: shorter courses of intravenous antibiotics are effective


This comprehensive study reinforces the importance of an accurate and conscious indication for the use of antibiotics, not only in pediatrics, but in all medical fields. The use of antimicrobials in unspecified situations or improper administration under recommended conditions can not only lead to individual complications in terms of side effects and financial costs, but to threats in society to the development of bacterial resistance.


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# Butler AM, Brown DS, Durkin MJ, et al. Association of inappropriate outpatient pediatric antibiotic prescriptions with adverse drug events and health expenses. JAMA Netw Open. 2022; 5 (5): e2214153. DOI: 10.1001 / jamanetworkopen.2022.14153

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