Inappropriate antibiotics for non-hospitalized children cost at least US$74 million – Washington University School of Medicine in St. Louis

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Such prescriptions can lead to complications such as diarrhea, skin rashes

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According to a new study from Washington University School of Medicine in St. Louis and The Pew Charitable Trusts, antibiotics inappropriately prescribed to non-hospitalized children resulted in at least $74 million in additional health care costs in the United States in 2017.

Children who were prescribed unnecessary or inappropriate antibiotics in outpatient settings, such as doctors’ offices and urgent care centers, were also up to eight times more likely to develop complications such as diarrhea and rashes that children treated according to standard medical guidelines.

The findings, published May 26 in JAMA Network Open, underscore the need to better manage antibiotic use outside of hospital settings.

“Inappropriate prescribing of antibiotics is unfortunately very common and results in adverse drug events and millions of dollars in preventable healthcare costs,” said the lead author. Anne Mobley Butler, Ph.D., assistant professor of medicine in the Division of Infectious Diseases at the University of Washington. “Sometimes parents think the worst that can happen is that the antibiotic just won’t help their child. But antibiotics are not harmless – they can cause adverse drug events. Clinicians must ensure that antibiotics are used only in the way most likely to benefit the patient.

Antibiotics kill bacteria, not viruses, but doctors still frequently prescribe antibiotics for viral infections. For bacterial infections, antibiotics can help, but choosing an appropriate antibiotic agent is important, and doctors don’t always follow guideline recommendations. A previous study suggests that about 29% of antibiotic prescriptions for non-hospitalized children nationwide are inappropriate.

At the population level, the use of antibiotics leads to the development of antibiotic-resistant bacteria. These bacteria cause hard-to-treat infections that lead to 35,000 deaths each year in the United States. But less is known about the individual health risks and economic costs associated with the inappropriate use of antibiotics.

Researchers analyzed data from private health insurance claims for children aged 6 months to 17 years who were diagnosed with one of eight common infections – three bacterial (ear infections with pus, sore throat and sinus infections) and five viral (ear infections without pus, bronchitis, bronchiolitis, flu and colds). In total, they identified 2.8 million children who were seen for such infections in clinics, emergency rooms, urgent care centers and doctors’ offices at some point between 1 April 2016 and September 30, 2018.

Unnecessary and inappropriate antibiotic prescriptions increased the risk of children experiencing certain medical complications. Children who received an antibiotic not recommended for bacterial infections had a three to eight times higher risk of developing Clostridiodes difficile (C.diff) infection, a life-threatening intestinal infection with diarrhea and inflammation that is associated with disruptions in the community of helpful bacteria that normally live in the gut. They were also at high risk of developing diarrhea not caused by C difference.; nausea, vomiting and abdominal pain; and severe allergic reactions such as anaphylaxis. For some viral infections, children who received antibiotics unnecessarily had a higher risk of developing rashes or unspecified allergies compared to children who did not receive antibiotics appropriately.

“Taking antibiotics when they’re not needed, or taking the wrong antibiotic when needed, accelerates the threat of dangerous superbugs and has serious consequences for individual patients,” said David Hyun, MD, who directs the antibiotic from The Pew Charitable Trusts. resistance project and is a co-author of the study. “We hope this research will serve as a roadmap to help health systems, insurers and other healthcare organizations in their efforts to strengthen efforts to improve antibiotic prescribing, protect the health of kids and save money.”

In addition to causing avoidable suffering, inappropriate antibiotics are costly because they lead to antibiotic treatment failures and additional medical complications that require follow-up visits and medical prescriptions. In 2017, improper selection of antibiotics for bacterial ear infections cost families and insurance companies an average of $56 per case, representing $25.3 million in excess healthcare costs nationwide, only for children with private insurance. The total cost for all children is probably much higher. Improperly treated sore throats were $21.3 million, sinus infections $7.1 million, flu $1.6 million and colds $19.1 million nationwide among children with private insurance. Unnecessary antibiotic prescriptions for viral bronchitis or bronchiolitis did not result in additional medical complications or additional costs.

Remarkably, inappropriate prescriptions for viral ear infections actually saved $96 per case, a reduction of $15.4 million nationwide in health care costs for children. with private health insurance. The researchers suspect this may be at least partly due to diagnostic coding errors, in which some bacterial ear infections were misclassified as viral ear infections. In other words, the benefit observed in this study may be due to the correct prescription of antibiotics for mislabeled bacterial ear infections rather than the incorrect treatment of viral ear infections.

Many hospitals have implemented so-called antibiotic stewardship programs to promote the appropriate use of antibiotics to reduce the spread of antibiotic resistance, decrease the number of infections caused by multidrug-resistant bacteria, and improve patient outcomes. patients. These programs are less common in outpatient settings such as urgent care centers and doctors’ offices.

“This study continues to show that we need to do a better job of ensuring that antibiotics are used appropriately in all health care settings,” said the lead author. Jason Newland, MD, professor of pediatrics at the University of Washington in the Division of Pediatric Infectious Diseases. “Our failure to do so has real costs, both to children’s health and to our collective wallet. We know how to prescribe antibiotics according to guidelines, and it’s time we started doing more to make sure antibiotics are always used correctly.

Butler AM, Brown DS, Durkin MJ, Sahrmann JM, Nickel KB, O’Neil CA, Olsen MA, Hyun DY, Zetts RM, Newland JG. Association of inappropriate pediatric outpatient antibiotic prescribing with adverse drug events and health care expenditure. JAMA network open. May 26, 2022. DOI: 10.1001/jamanetworkopen.2022.14153

This work was supported by The Pew Charitable Trusts and the National Center for Advancing Translational Sciences, grant number KL2 TR002346. Data programming for this study was performed by the Center for Administrative Data Research, which is supported in part by the University of Washington Institute for Clinical and Translational Sciences, National Center for Advancing Translational Sciences grant number UL1TR002345 (NCATS) from the National Institutes of Health (NIH) and grant number R24HS19455 through the Agency for Healthcare Research and Quality (AHRQ). Preliminary work for this publication was supported in part by funds from the Center for Health Economics and Policy at the Institute for Public Health at Washington University in St. Louis.

The 1,700 doctors at the University of Washington Medical School are also part of the medical staff of Barnes-Jew and St. Louis Children’s hospitals. The School of Medicine is a leader in medical research, teaching, and patient care, and is currently #4 in National Institutes of Health (NIH) research funding. Through its affiliations with Barnes-Jewish and St. Louis Children’s Hospitals, the School of Medicine is linked to BJC Healthcare.


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