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Declining Prescription Rates Coincide With Increased Attention to the Problem of Antimicrobial Resistance
June 16, 2002 —: A survey of office-based physicians shows antibiotic prescriptions decreased overall and for common respiratory tract infections among American children and young teenagers during the 1990s, according to an article in the June 19 issue of The Journal of the American Medical Association (JAMA).
Linda F. McCaig, M.P.H., of the National Center for Health Statistics, Centers for Disease Control and Prevention in Hyattsville, Md., and colleagues assessed changes in antimicrobial prescribing rates overall and for respiratory tract infections for children and adolescents younger than 15 years of age.
According to background information cited in the article, antimicrobial prescribing rates for children by physicians in office-based practice increased by 48 percent in the United States. from 1980 through 1992. Inappropriate use of antibiotics has contributed to the development of antimicrobial resistance. To combat development of antimicrobial resistance, professional and public health organizations undertook efforts to promote appropriate antimicrobial prescribing.
The authors analyzed data from the National Ambulatory Medical Care Survey (NAMCS). The data provided by 2,500 to 3,500 office-based physicians included information on 6,500 to 13,600 pediatric visits during two-year periods from 1989 to 1990 through 1999 to 2000. Data from the visit record included demographic information, diagnoses, and medication prescribed, including antimicrobial agents. (Antimicrobials are drugs used to treat infections, and for this study included antibiotics such as penicillin, erythromycin and others.)
"The average population-based annual rate of overall antimicrobial prescriptions decreased 40 percent from 838 per 1,000 children and adolescents younger than 15 years in 1989 to 1990 to 503 in 1999 to 2000," the authors write.
Both population- and visit-based prescribing rates decreased for pharyngitis (inflammation of the hollow tube in the back of the throat; a common cause of sore throat) and upper respiratory tract infection. There were declines in the population-based prescribing rate for otitis media (inflammation of the middle ear) and bronchitis. Prescribing rates for sinusitis (infection of the sinuses) remained stable.
"The decline in pediatric antimicrobial prescribing by office-based physicians, especially the significant decline in overall visit-based prescribing rates observed from 1995 to1996 through 1999 to 2000, coincides with increased attention by the media to the problem of antimicrobial resistance and with efforts by many organizations to promote the appropriate use of antimicrobials," the authors write.
They point out that despite the decline in antimicrobial prescribing for children, pneumococcal resistance increased through the 1990s. "It is important to continue efforts to improve appropriate antimicrobial prescribing and to use data from surveys, such as the NAMCS, for the evaluation of ongoing efforts," the authors conclude.
Community-Wide Campaign Effective in Reducing Antibiotic Prescriptions
In an accompanying article, Joseph F. Perz, Dr.P.H., formerly of the Epidemiology Program Office, Centers for Disease Control and Prevention in Atlanta, and colleagues report that a community-wide educational intervention reduced antibiotic prescription rates by 11 percent among children in Knox County, Tennessee.
The authors assessed the impact of a campaign that ran from May 1997 through April 1998 in Knox County, and was designed to reduce unnecessary antibiotic use. The authors compared trends in antibiotic prescribing rates among Medicaid recipients younger than age 15 in Knox County with those in three other major urban counties in Tennessee before, during, and after the educational intervention.
"Antibiotic prescription rates declined 19 percent and 8 percent among Knox County and control county children, respectively, yielding an 11 percent intervention-attributable decline," the authors write.
"The intervention-attributable decrease in prescription rates was greatest among children aged 1 to less than 5 years (among white children, 8 percent; among black children, 18 percent)," they report.
"Reductions in prescribing were sustained for at least one year after Knox County's campaign ended, though the greatest effect occurred during the intervention year," they write.
A national action plan to address the problem of antibiotic-resistant infections in the United States was recently developed by a governmental task force. "The decline in antibiotic prescribing documented after the Knox County intervention should encourage these broader efforts," the authors conclude.