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    Increased use of second-generation macrolide antibiotics for children in nine health plans in the United States

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    Authors
    Stille, Christopher J.
    Andrade, Susan E.
    Huang, Susan S.
    Nordin, James D.
    Raebel, Marsha A.
    Go, Alan S.
    Chan, K. Arnold
    Finkelstein, Jonathan A.
    UMass Chan Affiliations
    Meyers Primary Care Institute
    Department of Pediatrics
    Document Type
    Journal Article
    Publication Date
    2004-11-03
    Keywords
    Adolescent
    Anti-Bacterial Agents
    Child
    Child, Preschool
    Drug Utilization
    Female
    Humans
    Infant
    Macrolides
    Male
    Managed Care Programs
    Physician's Practice Patterns
    United States
    Health Services Research
    Life Sciences
    Medicine and Health Sciences
    Pediatrics
    Primary Care
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    Link to Full Text
    http://dx.doi.org/10.1542/peds.2004-0311
    Abstract
    BACKGROUND: Widespread use of broad-spectrum antibiotics contributes to increasing rates of bacterial resistance to antibiotics. Second-generation macrolides have become popular for use among children because of their broad spectrum and favorable dosing and side-effect profiles, although experts do not generally recommend them for use as initial treatment of infections among younger children. OBJECTIVE: To assess trends in second-generation macrolide use from 1996 to 2000 among children treated as outpatients in 9 US health plans, including associated diagnoses and use as initial treatment. METHODS: We sampled claims data for 25000 children, 3 months to <18 years of>age, who were enrolled between September 1, 1995, and August 31, 2000, in each of 9 US health plans. Medications dispensed were linked with ambulatory visit claims to assign diagnoses. Dispensings without another antibiotic dispensing recorded in the previous 42 days were analyzed as initial treatment of a new illness episode. We analyzed trends in prescribing overall, for initial therapy, and, within specific diagnoses, for differences among health plans. RESULTS: From 1995-1996 to 1999-2000, although overall antibiotic use decreased from 1.15 to 0.91 dispensings per person-year, second-generation macrolide use increased from 0.022 to 0.063 dispensings per person-year. Use as a proportion of all antibiotic dispensings increased from 1.9% to 6.9%, and use as initial therapy increased from 1.4% to 6%. For children <6 years of>age, second-generation macrolide use as initial therapy increased from 0.9% to 5.0% for otitis media and from 5.2% to 24.0% for pneumonia. There was a wide range of prescribing rates among health plans during the last year of the study, from 0.006 to 0.135 dispensings per person-year. CONCLUSIONS: Despite recent trends toward decreased antibiotic use among children, the use of second-generation macrolides among children has increased dramatically, even among younger children, for whom use for initial treatment of illness is not recommended. Large differences in prescribing rates exist among health plans. Continued efforts to promote the use of narrower-spectrum agents when appropriate are needed.
    Source
    Pediatrics. 2004 Nov;114(5):1206-11. Link to article on publisher's site
    DOI
    10.1542/peds.2004-0311
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/38894
    PubMed ID
    15520097
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1542/peds.2004-0311
    Scopus Count
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