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Войти в исследования The Journal of pediatrics · 2026
Antibiotic Utilization in Medicaid-Enrolled Children: Associations with Medical Complexity.
СтатьяНазвание и аннотация: Перевод в очереди
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Snow Kathleen D, Hall Matthew, Berry Jay G, Mansbach Jonathan M
Аннотация
OBJECTIVES: To describe contemporary patterns of pediatric outpatient antibiotic utilization and to identify patient-level factors associated with high antibiotic use.
STUDY DESIGN: We conducted a retrospective cohort study of outpatient antibiotic prescription claims using the Merative MarketScan Medicaid Database. We included children aged 0-18 years continuously enrolled in Medicaid from January 1, 2023 to December 31, 2023. Outcomes included (1) annual outpatient antibiotic prescription fill rates per 1000 persons and (2) high antibiotic utilization, defined as >50 antibiotic days per year. Multivariable logistic regression assessed associations between covariates (patient demographics, insurance features, and clinical complexity) and high antibiotic utilization.
RESULTS: Among 2 357 642 Medicaid-enrolled children, 921 350 (39.1%) filled ≥ 1 antibiotic prescription in 2023. Antibiotic prescription rates increased with medical complexity (P < .001) from 514 (95% CI: 513 - 516) per 1000 persons in children without chronic conditions to 2882 (95% CI: 2850 - 2915) in children with ≥3 complex chronic conditions (CCCs). Penicillins, cephalosporins, and macrolides comprised 93.0% of antibiotic prescriptions in healthy children, vs 65.0% in children with ≥3 CCCs. High antibiotic utilization was associated with younger age, female sex, blind/disabled basis of Medicaid eligibility, capitated plans, and increasing CCCs.
CONCLUSIONS: Children with multiple CCCs have substantially higher antibiotic exposure and greater use of broad-spectrum antibiotics. These children may be an under-recognized target population for antibiotic stewardship interventions.
STUDY DESIGN: We conducted a retrospective cohort study of outpatient antibiotic prescription claims using the Merative MarketScan Medicaid Database. We included children aged 0-18 years continuously enrolled in Medicaid from January 1, 2023 to December 31, 2023. Outcomes included (1) annual outpatient antibiotic prescription fill rates per 1000 persons and (2) high antibiotic utilization, defined as >50 antibiotic days per year. Multivariable logistic regression assessed associations between covariates (patient demographics, insurance features, and clinical complexity) and high antibiotic utilization.
RESULTS: Among 2 357 642 Medicaid-enrolled children, 921 350 (39.1%) filled ≥ 1 antibiotic prescription in 2023. Antibiotic prescription rates increased with medical complexity (P < .001) from 514 (95% CI: 513 - 516) per 1000 persons in children without chronic conditions to 2882 (95% CI: 2850 - 2915) in children with ≥3 complex chronic conditions (CCCs). Penicillins, cephalosporins, and macrolides comprised 93.0% of antibiotic prescriptions in healthy children, vs 65.0% in children with ≥3 CCCs. High antibiotic utilization was associated with younger age, female sex, blind/disabled basis of Medicaid eligibility, capitated plans, and increasing CCCs.
CONCLUSIONS: Children with multiple CCCs have substantially higher antibiotic exposure and greater use of broad-spectrum antibiotics. These children may be an under-recognized target population for antibiotic stewardship interventions.