St. Louis, MO—Inappropriate antibiotics prescribed to pediatric outpatients are not only expensive, but also significantly increase the risk of complications such as diarrhea and skin rashes, according to a new report.

A study in the Journal of the American Medical Association Network Open stated that unnecessary antibiotics for children resulted in at least $74 million in excess healthcare costs in the United States in 2017. Even worse, according to researchers from Washington University School of Medicine in St. Louis and The Pew Charitable Trusts, they increased the risk for a broad range of ADRs.

According to the study, "For children with bacterial infections, inappropriate antibiotic prescriptions were usually associated with higher risk of C. [Clostridioides] difficile infection (e.g., children with suppurative otitis media (OM): HR, 6.23; 95% CI, 2.24-17.32); non-C. difficile diarrhea (e.g., children with suppurative OM: HR, 1.30; 95% CI, 1.20-1.41); and nausea, vomiting, or abdominal pain (e.g., children with suppurative OM: HR, 1.20; 95% CI, 1.10-1.30) and lower risk of skin rash or urticaria (e.g., children with suppurative OM: HR, 0.62; 95% CI, 0.58-0.66) as well as unspecified allergy (e.g., children with suppurative OM: HR, 0.67; 95% CI, 0.57-0.78)."

Children with viral infections who were prescribed antibiotics—a guideline-discordant but common practice—had increased risks of skin rash or urticaria as well as unspecified allergy for viral upper respiratory infection and nonsuppurative OM. Those risks were up to eight times higher than those in children who had not received antibiotics.

"Approximately 29% of outpatient antibiotics prescribed to children in the United States are inappropriate," the authors wrote. "These include a large proportion of children inappropriately prescribed any antibiotic agent for a viral infection (e.g., 21% of viral upper respiratory infection [URI] diagnoses) or inappropriately prescribed a non-first-line antibiotic agent for a bacterial infection (e.g., 33% of treated otitis media [OM] diagnoses, 40% of treated pharyngitis diagnoses, and 48% of treated sinusitis diagnoses), i.e., non-guideline-concordant antibiotic use.Ó

The study puts it this way: "Inappropriate antibiotic prescriptions are harmful on a societal level because they propel the spread of antimicrobial resistance and harmful on an individual level because they are associated with adverse drug events (ADEs), such as allergic reactions (e.g., anaphylaxis, skin rash) and microbiome disruption-related conditions (e.g., Clostridioides difficile infection)."

The authors cite a previous study finding that about 29% of antibiotic prescriptions for nonhospitalized children nationwide are inappropriate.

"Sometimes parents think that the worst that could happen is that the antibiotic just won't help their child. But antibiotics are not harmless—they can cause adverse drug events. Clinicians need to ensure that antibiotics are only used in the way that is most likely to benefit the patient," stated lead author Anne Mobley Butler, PhD, of Washington University.

To reach their conclusions, the researchers analyzed private health insurance claims data for children aged 6 months to 17 years who were diagnosed with any of these eight common infections:

• bacterial ear infection with pus
• bacterial infection with sore throat
• bacterial sinus infection
• viral ear infection without pus
• bronchitis
• influenza
• colds

They then identified 2.8 million children who were seen for those infections in clinics, emergency rooms, urgent care centers, and doctors' offices from April 1, 2016, to September 30, 2018.

"Taking antibiotics when they're not needed, or taking the wrong antibiotic when one is needed, accelerates the threat of dangerous superbugs, and has serious consequences for individual patients," stated coauthor David Hyun, MD, who directs The Pew Charitable Trusts' antibiotic resistance project. "We hope this research will serve as a roadmap to help health systems, insurers and other health care organizations as they work to strengthen efforts to improve antibiotic prescribing, protect children's health and save money."

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