Wattles Bethany A, Smith Michael J, Feygin Yana, Jawad Kahir S, Bhadury Sagnik, Sun Jingchao, Kong Maiying, Woods Charles R
Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA.
J Pediatric Infect Dis Soc. 2022 Dec 5;11(11):492-497. doi: 10.1093/jpids/piac079.
Little is known about the distribution of antibiotic use in individual children over time. The amoxicillin index is a recently proposed metric to assess first-line antibiotic prescribing to children.
We constructed a cohort of continuously enrolled Medicaid children using enrollment claims from 2012 to 2017. Pharmacy claims were used to identify antibiotic prescription data.
Among 169 724 children with 6 years of Medicaid enrollment, 10 804 (6.4%) had no antibiotic prescription claims during the study period; 43 473 (25.6%) had 1-3 antibiotics; 34 318 (20.2%) had 4-6 antibiotics; 30 994 (18.3%) had 7-10; 35 018 (20.6%) had 11-20; and 15 117 (8.9%) children had more than 20 antibiotic prescriptions. Overall, the population had a median total of 6 antibiotic prescriptions during the study period, but use was higher in certain patient groups: younger age (8 antibiotic fills over the 6-year period, [IQR 4-14]), White children (7 [IQR 3-13], compared to 3 [IQR 1-6] in Black children), rural settings (9 [IQR 4-15]) and chronic conditions (8 [IQR 4-15]). Higher-use groups also had lower rates of amoxicillin fills, reported as amoxicillin indices.
Antibiotic use is common among most children insured by Kentucky Medicaid. A number of fills over time were higher in younger children, and in White children, children living in rural settings and children with chronic conditions. Patients with higher recurrent antibiotic use are important targets for designing high-impact antibiotic stewardship efforts.
关于个体儿童抗生素使用随时间的分布情况，人们了解甚少。阿莫西林指数是最近提出的一种评估儿童一线抗生素处方的指标。
我们利用2012年至2017年的参保申请构建了一个连续参保医疗补助儿童队列。药房申请用于识别抗生素处方数据。
在169724名有6年医疗补助参保记录的儿童中，10804名（6.4%）在研究期间没有抗生素处方申请；43473名（25.6%）有1至3种抗生素；34318名（20.2%）有4至6种抗生素；30994名（18.3%）有7至10种；35018名（20.6%）有11至20种；15117名（8.9%）儿童有超过20种抗生素处方。总体而言，该人群在研究期间抗生素处方总数的中位数为6种，但某些患者群体的使用量更高：年龄较小（6年期间8次抗生素配药，[四分位距4 - 14]）、白人儿童（7次[四分位距3 - 13]，黑人儿童为3次[四分位距1 - 6]）、农村地区（9次[四分位距4 - 15]）以及患有慢性病的儿童（8次[四分位距4 - 15]）。高使用量组的阿莫西林配药率也较低，以阿莫西林指数表示。
抗生素使用在肯塔基医疗补助保险覆盖的大多数儿童中很常见。随着时间推移，年龄较小的儿童、白人儿童、农村地区儿童以及患有慢性病的儿童的配药次数较多。反复大量使用抗生素的患者是设计高效抗生素管理措施的重要目标人群。
