Divisions of Infectious Diseases.
Quantitative Sciences Unit, Biomedical Informatics Research Division, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Pediatrics. 2024 Jun 1;153(6). doi: 10.1542/peds.2023-065003.
Repurposed medications for acute coronavirus disease 2019 (COVID-19) continued to be prescribed after results from rigorous studies and national guidelines discouraged use. We aimed to describe prescribing rates of nonrecommended medications for acute COVID-19 in children, associations with demographic factors, and provider type and specialty.
In this retrospective cohort of children <18 years in a large United States all-payer claims database, we identified prescriptions within 2 weeks of an acute COVID-19 diagnosis. We calculated prescription rate, performed multivariable logistic regression to identify risk factors, and described prescriber type and specialty during nonrecommended periods defined by national guidelines.
We identified 3 082 626 COVID-19 diagnoses in 2 949 118 children between March 7, 2020 and December 31, 2022. Hydroxychloroquine (HCQ) and ivermectin were prescribed in 0.03% and 0.14% of COVID-19 cases, respectively, during nonrecommended periods (after September 12, 2020 for HCQ and February 5, 2021 for ivermectin) with considerable variation by state. Prescription rates were 4 times the national average in Arkansas (HCQ) and Oklahoma (ivermectin). Older age, nonpublic insurance, and emergency department or urgent care visit were associated with increased risk of either prescription. Additionally, residence in nonurban and low-income areas was associated with ivermectin prescription. General practitioners had the highest rates of prescribing.
Although nonrecommended medication prescription rates were low, the overall COVID-19 burden translated into high numbers of ineffective and potentially harmful prescriptions. Understanding overuse patterns can help mitigate downstream consequences of misinformation. Reaching providers and parents with clear evidence-based recommendations is crucial to children's health.
在严格的研究结果和国家指南不鼓励使用的情况下，用于治疗急性 2019 冠状病毒病（COVID-19）的重新利用药物仍在开具。我们旨在描述儿童急性 COVID-19 非推荐药物的开具率，以及与人口统计学因素和提供者类型及专业的关联。
在这项回顾性队列研究中，我们在一个大型美国全支付者索赔数据库中纳入了 18 岁以下的儿童，识别了在急性 COVID-19 诊断后 2 周内的处方。我们计算了处方率，进行多变量逻辑回归以确定危险因素，并描述了在国家指南定义的非推荐期内的开方者类型和专业。
我们在 2020 年 3 月 7 日至 2022 年 12 月 31 日期间，从 2 949 118 名儿童中识别出了 3 082 626 例 COVID-19 诊断。在非推荐期（HCQ 为 2020 年 9 月 12 日，伊维菌素为 2021 年 2 月 5 日）内，羟氯喹（HCQ）和伊维菌素分别在 0.03%和 0.14%的 COVID-19 病例中开具，且各州之间差异较大。在阿肯色州（HCQ）和俄克拉荷马州（伊维菌素），处方率是全国平均水平的 4 倍。年龄较大、非公共保险以及急诊或紧急护理就诊与任何一种处方的风险增加相关。此外，居住在非城市和低收入地区与伊维菌素的处方相关。全科医生开具处方的比例最高。
尽管非推荐药物的处方率较低，但总体 COVID-19 负担转化为大量无效和潜在有害的处方。了解过度使用模式有助于减轻错误信息的下游后果。向提供者和家长提供明确的基于证据的建议对于儿童的健康至关重要。
