Antibiotic Use in Pediatric Primary Care Plunges During COVID-19 Pandemic

(Reuters Health) – Fewer children received antibiotics in primary care practices during the COVID-19 pandemic, driven by a steep decline in prescriptions for upper respiratory infections, a recent study suggests.

Researchers examined data on antibiotic prescribing in 27 pediatric primary care practices in the greater Philadelphia area between January 1, 2018, and June 30, 2021. Overall, there were a total of 69,327 antibiotic prescriptions during a pre-pandemic period running from April through December 2019. Antibiotic prescriptions fell 72.7% to 18,935 during a pandemic period running from April through December 2020.

Most of this decrease, 87.3%, was due to a reduction in antibiotic prescriptions at sick visits for upper respiratory tract infections during the pandemic period, researchers report in Pediatrics.

“Our group and others found that the occurrence of visits for non-COVID-19 community respiratory infections decreased with the onset of the pandemic,” said lead study author Dr. Lauren Dutcher, an instructor of medicine and attending physician in the division of infectious diseases at the University of Pennsylvania Perelman School of Medicine in Philadelphia.

“Although we can’t rule out that some patients may have either avoided care or gone elsewhere for respiratory symptoms, this change was likely in part a result of the associated public health measures and behavior changes that prevented community transmission,” Dr. Dutcher said by email.

When researchers examined the trend using interrupted time series analysis, they found that overall antibiotic prescriptions dropped from 31.6 to 6.4 per 1,000 patients in April 2020, a decrease of 25.2 prescriptions per 1,000 patients.

That decrease was sustained through the end of the study period. From April 2020 to June 2021, this analysis found a small and nonsignificant monthly increase in antibiotic usage of 0.25 prescriptions per 1,000 patients.

While prescriptions were more common overall among younger children in the study, in the age bands from 1 to 4 years and 5 to 11 years, researchers found that antibiotic prescriptions declined and then held steady at lower levels across all age groups.

Public health measures implemented during the pandemic, including masking and social distancing, may have resulted in reduced community transmission of respiratory tract infections and related antibiotic prescriptions, the study team points out.

More research is still needed to determine how relaxing of these mitigation measures along with increased availability of COVID-19 vaccination for children influences antibiotic utilization in this population, the authors also note.

One limitation of the study is that the analysis was limited to patients within one health system, and it’s possible that antibiotic prescribing patterns might differ elsewhere. Researchers also lacked data to distinguish between appropriate and inappropriate antibiotic usage, Dr. Dutcher said.

“Pre-pandemic, it is known that some of this prescribing for respiratory infections was unnecessary, given that viruses are a significant cause of respiratory tract infection,” Dr. Dutcher said. During the study period, however, “it is possible that some patients avoided needed care during this time when an antibiotic was warranted,” Dr. Dutcher said.

“This study can remind clinicians that the decision to prescribe an antibiotic for a respiratory tract infection should take into account the clinical data and guidelines for appropriate prescribing,” Dr. Dutcher advised.

SOURCE: Pediatrics, online January 11, 2022.

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