Implementation of pneumococcal vaccine programs linked to decreased antibiotic prescription

1. After implementation of practice guidelines advocating rational antibiotic prescribing for primary care providers, as well as a 7-valent pneumococcal conjugate (PCV7) catch-up program followed by a standard PCV13 vaccination program, the 1-year risk of antibiotic prescription in children from birth to 1-year of life decreased after each event.

2. First antibiotic prescriptions occurred more frequently with increasing age and during the winter months.

Evidence Rating: 2 (Good)

 Study Rundown: Antibiotics are often unnecessarily prescribed in pediatric primary care practices, particularly for respiratory tract infections. Numerous efforts, such as clinical practice guidelines, have been implemented to optimize antibiotic prescription. Previous studies trending antibiotic prescribing practices in early childhood have been limited to cross-sectional data that lacks well-defined cohorts. In this study, researchers characterized the effects of birth season, birth year cohort and interruption time points – or events hypothesized to have population-level effects on antibiotic use infancy – on the prescription of antibiotics during early childhood. Their data showed a decrease in the proportion of studied infants who received antibiotics and the overall rate of antibiotic prescriptions per infant year from 2004 to 2012. With respect to birth season and birth year, data showed that first antibiotic prescriptions occurred more frequently with increasing age and during the winter months, corresponding with previously noted patterns of acute otitis media, which peaks during colder seasons and for children >6 months of age. Interruption time points including the International Road Federation (IRF) bulletin advocating for rational antibiotic prescribing among general practitioners (April 1, 2007), the release of the PCV7 catch-up vaccination program (October 1, 2007), and the PCV13 vaccination program (January 1, 2011) were followed by a decrease in the 1-year risk of redeeming antibiotics. The study was limited by the lack of data on diagnostic indications for antibiotic prescription and by not accounting for local differences in circulating illnesses each year. Studies such as this may assist pediatricians in risk stratifying patients who may have a higher likelihood of being prescribed antibiotics based on their time of birth.

Click to read the study, published today in Pediatrics

Relevant Reading: Antibiotic prescribing for children in primary care and adherence to treatment guidelines

 In-Depth [retrospective cohort]: The study followed 561 729 live births from birth to 1 year of age or to death/emigration in Denmark from 2004 to 2012, identified through the Danish Medical Birth Registry (DMBR). Data on redeemed antibiotic prescriptions identified through the DMBR was used as a proxy for antibiotic use. Birth cohorts were grouped by week, month, season, and year of birth. Overall, antibiotic prescriptions made up 46% of all drug prescriptions during the study cohort’s infancy, with an overall rate of 72 redeemed antibiotic prescriptions per 100 infant years of follow-up. The 1-year risk of having at least 1 redeemed antibiotic prescription during infancy was 39.5% (99%CI 3.9.3-39.6%) and the hazard, or instantaneous risk of a first prescription antibiotic increased with age and tended to be more common during winter, peaking in February. In terms of trends over time, the overall 1-year risk of having at least 1 redeemed antibiotics prescription decreased from 40.7% (births in 2004) to 34.6% (births in 2012). After rollout of the PCV7 catch-up vaccination program and publication of the IRF bulletin, the overall 1-year risk of antibiotic prescription decreased by 4.4% over 14 months (99%CI 3.4-5.5%). After the childhood vaccination program’s replacement of PCV7 with PCV13, overall risk decreased by 6.9% over the following 3 years (99%CI 4.4-9.3%)

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