The amount of antibiotics prescribed for children in primary care decreased dramatically after the COVID-19 pandemic. Recent research suggests that this drop has been sustained until June 2021.
Lauren Dutcher, MD, with the division of infectious diseases at Hospital of the University of Pennsylvania in Philadelphia conducted an investigation of 27 pediatric primary care practices across the United States. The study examined encounters between January 1st, 2018 until June 30, 2021.
Researchers found a 72.7 percent reduction in the prescriptions for antibiotics in the period from April 2019 to December 2019 , when they compared it to the same period in 2020.
Prescriptions remained at lower levels, driven primarily by decreases in respiratory tract infection (RTI) encounters. The number of patients increased only in April 2021, as the authors note.
The results were published online on Jan. 11 in Pediatrics.
Researchers found 69.327 prescriptions for antibiotics in the period of April and December 2019, and 18,935 in the same period in 2020.
The authors state that 87.3 percent of the decrease was due to a reduction in prescriptions for visits for respiratory tract infections (RTI).
Both prescribing and acute non-COVID-19 respiratory tract infection diagnoses have decreased.
Researchers conclude that the reduction in viral RTI transmission played a major role in the reduced number of RTI pediatric visits and prescriptions for antibiotics.
Dutcher told this publication the reduction could be due to a combination of less viral transmission of respiratory infections and, in part, by distancing and masking but also avoidance of health care services in the case of a pandemic.
She stated that the data suggest the need for proper prescribing.
She stated that the use of antibiotics is largely driven by respiratory illnesses. This should continue to alert providers on how often it can be unneeded.
Dutcher said there was probably an increase in secondary infections with bacterial as well as the viral infections.
The research is more thorough than some other previous studies, the authors write.
“Although other studies have shown early reductions in RTIs and antibiotic prescribing during the COVID-19 epidemic, to our knowledge this is the first study to demonstrate an ongoing decrease in antibiotic prescribing in pediatric primary care throughout 2020 and early 2021,” they write.
The findings also suggest advantages of preventive measures during the pandemic, as the authors say.
They state that their data suggests that the reduction in transmission of community viral RTI through social distancing or masking correlates with a decrease in antibiotic prescribing.
Kao-Ping Chha MD, a pediatrician at the University of Michigan Ann Arbor and associate professor of pediatrics said that the decreases indicate one of two things that the children aren’t being sick as often during the course of a pandemic, or perhaps they are sick but not bringing it in.
He also said that if people were not sick, they would likely be seen in large numbers in emergency rooms with untreated infections.
He said, “We just haven’t seen that.”
He also stated that one of the main points made by the authors is that masks and distancing could help keep children safe from diseases beyond COVID-19.
He stated that longer-term data will be needed to determine if the trend in this article continues since children have returned to school and doctors began to see many cases of respiratory syncytialvirus (RSV).
Anecdotally he said that he has been prescribing more antibiotics recently for ear infections.
Dutcher said that despite the fact that her team hasn’t yet collected data until the end of the study , she believed it was likely that prescriptions have increased since June.
Chua said the reduction in visits also decreases the chance that a doctor will be tempted to give in to families’ demands to prescribe an antibiotic.
“Every visit for sick children is an opportunity to inappropriately prescribe antibiotics,” Chua said. Chua’s research discovered that nearly one quarter of all adult and pediatric prescriptions for antibiotics were unneeded.
This work was funded by an Centers for Disease Control and Prevention collaboration agreement Epicenters for the Prevention of Healthcare Associated Infections. Dutcher and Chua did not share any financial information.
This article first appeared on MDedge.com, part of the Medscape Professional Network.
