242 - Antibiotic Dispensing to U.S. Children, 2019-2023

Poster Number: 242
Publication Number: 242.1863

Background: Antibiotic dispensing to U.S. children was disrupted by the COVID-19 pandemic and amoxicillin shortage in late 2022. Whether these disruptions were sustained is unknown.

Objective: To assess changes in antibiotic dispensing to children from 2019-2023.

Design/Methods: We analyzed antibiotic dispensing to children aged 0-17 from January 2019-June 2023 using the IQVIA Longitudinal Prescription Database, an all-payer database that reports 92% of prescriptions dispensed from U.S. pharmacies. For each month during January 2020-June 2023, we calculated the percent change in dispensing compared to the corresponding month in 2019. We conducted analyses overall, by age group (0-4, 5-11, 12-17 years), and by antibiotic. To explore the mechanism of changes, we calculated the percent change in the monthly number of visits for acute infections (e.g., respiratory/urinary tract infections) and in the rate of antibiotic dispensing within 3 days of these visits compared to 2019. Visit data derived from the IQVIA Medical Claims Database, which captures outpatient and inpatient visits from 40 million children annually.

Results: Antibiotic dispensing to children was 68.7% below 2019 levels in April 2020 and remained below these levels until June 2022. In June 2023, antibiotic dispensing was 8.9% higher than in June 2019 across all ages, 1.4% higher in those 0-4 years, 29.5% higher in those 5-11 years, and 4.2% lower in those 12-17 years (Fig 1a). In November 2022, amoxicillin dispensing was 0.6% above 2019 levels. In contrast, cefdinir and amoxicillin/clavulanate dispensing was 56.8-60.6% above these levels (Fig 1b). In June 2023, dispensing of these two drugs was still 43.7%-43.9% above 2019 levels among children aged 5-11 years, but was only slightly above these levels in other age groups (Fig 2a-2b). In June 2023, the number of visits for acute infections and the rate of antibiotic dispensing within 3 days of these visits were 31.0% and 8.9% above 2019 levels in children aged 5-11 years (Fig 3a-3b).

Conclusion(s): In June 2023, antibiotic dispensing to children exceeded the level in June 2019. This change was driven by increased antibiotic dispensing to children aged 5-11 years, which in turn may have been driven by increased visits for acute infections and increased antibiotic prescribing after these visits. Dispensing of cefdinir and amoxicillin/clavulanate surged during the amoxicillin shortage, but these changes were only sustained in children aged 5-11 years. While antibiotic stewardship initiatives are needed in all children, findings suggest targeted initiatives focused on school-aged children may be warranted.