Study: Few Docs Write Too Many Antibiotic Scripts for Kids

In one state, only a tiny fraction of outpatient providers wrote many of the prescriptions for broad-spectrum antibiotics given to children and teens, researchers found.

Less than 2% of providers in Tennessee accounted for about 25% of broad-spectrum antibiotic prescriptions for pediatric patients, reported Sophie Katz, MD, MPH, of Vanderbilt University Medical Center in Nashville, and colleagues.

Female pediatricians and pediatricians who graduated medical school prior to 2000 were more likely to be high antibiotic prescribers, they wrote in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

"This research is a first step to identifying patient and provider characteristics that can be used to design stewardship interventions to improve antibiotic prescribing in our state," Katz said in a statement.

Katz and her group noted that antibiotic prescribing rates are highest in the southeast and Tennessee was the sixth highest U.S. state for outpatient antibiotic prescribing in 2016. They said that about 1,169 antibiotic prescriptions per 1,000 were written in Tennessee in 2016 versus the national rate of 836 per 1,000.

They specifically examined data from children and teens (age younger than 20) who had antibiotic prescriptions filled at outpatient pharmacies from January to December 2016 in Tennessee. They used the IQVIA Xponent database, which contains the total number of prescriptions in a particular class of drug at the prescriber level.

Overall, Tennessee's outpatient antibiotic prescribing rate for children and teens was 1,165 per 1,000 in 2016. About 20% of all pediatric outpatient antibiotic prescriptions were for children ages 0-2, though prescribing rates declined with increasing age, Katz and colleagues said. Amoxicillin was the most common antibiotic prescribed for each age group, but it accounted for smaller portions of antibiotic use as children got older -- from 44% of all prescriptions in the youngest children to 24% of prescriptions among children older than age 10.

Of the around 2 million antibiotic prescriptions in the database, 54% were written by physicians. Among physicians, pediatricians accounted for 57% of overall antibiotic prescriptions. About half of providers wrote less than 10 antibiotic prescriptions for children.

But there were 1,712 providers who each wrote over 300 antibiotic prescriptions. Of these, a group of 360 providers accounted for over 300 broad-spectrum antibiotic prescriptions each, or 24% of broad-spectrum antibiotic prescriptions. Of these, about 20% were located in a single county, but that was not wildly disproportionate, as the same county had 16% of the state's children.

Multivariable analyses comparing high prescribing general pediatricians to non-high prescribing pediatricians also found pediatricians in urban areas were less likely to be high prescribers versus those in rural areas.

"These data indicate that pediatricians, especially those high-prescribing providers in a specific county, are excellent focal points for future antimicrobial stewardship interventions," Katz and colleagues wrote. "Peer comparison of antibiotic prescribing rates may be a particularly effective intervention for outlier, high-prescribing providers."

Limitations to the data included that it only examined one state, which may limit the generalizability of the findings, and only included prescriptions dispensed by pharmacies, which does not account for the antibiotics dispensed during a patient encounter nor the actual amount of medication taken by patients, the authors said.

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