1913. Antibiotic prescribing in the pediatric Kentucky Medicaid population
Session: Poster Abstract Session: Antibiotic Stewardship: Pediatrics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • SMITH 10.25.16.pdf (527.2 kB)
  • Background:  Kentucky (KY) has the highest per capita antibiotic prescription rate of any state.  A better understanding of prescribing patterns is needed, especially in the pediatric population which typically has the highest prescription rates of all age groups.

    Methods: We reviewed pharmacy claims of children (age <20) covered by KY Medicaid in 2014.  National Drug Codes were used to identify systemic antibacterial agents;  oseltamivir use was measured as a surrogate for influenza season.  Patient (age, sex, race, urbanicity, date of service) and provider (type and specialty) characteristics were assessed.   Patterns of antibiotic use were summarized using descriptive statistics.   Prescription rates per 1000 children with a pharmacy claim in 2014 were calculated overall and for specific demographic groups.

    Results: 462,813 children had a pharmacy claim in 2014.  Of these 306,156 (77%) received 693,061 antibiotic prescriptions (median 2, interquartile range 1-3) in 2014.   The overall prescription rate was 1497 per 1000 children.  Antibiotics were more commonly prescribed during the winter months in temporal association with influenza season (Figure).    Prescription rates by selected demographic characteristics are presented in Table 1 and compared to national estimates when available.

    Demographic group

    Antibiotic Prescriptions Per 1000 Children

    KY Medicaid

    National Average

    Male

    1488

    841

    Female

    1680

    941

    Age (years)

    0-2

    1890

    1287

    3-9

    1549

    1018

    10-19

    1400

    691

    White

    1658

    *

    Black

    1025

    *

    Other

    1257

    *

    Urban

    1355

    *

    Non-urban

    1627

    *

    Specific antibiotics

    Amoxicillin

    580

    300

    Azithromycin

    341

    183

    Cefdinir

    160

    74

    Amoxicillin-Clavulanate

    150

    87

    *Not reported

    Provider specialties are listed below:

    Provider Specialty

    Percent of total (n=693,061) prescriptions

    General Practitioner

    39

    NP (Other)

    16

    Family NP

    13

    General Pediatrician

    12

    Physician Assistant

    7

    Conclusion: These results confirm the high antibiotic use seen in KY in national studies.   White, non-urban children had the highest prescription rates.  Analysis of 2015 data and linkage of pharmacy records to medical claims is underway to better understand the risk factors for antibiotic overuse in this population.  These data will be used to inform public health policy surrounding judicious use of antibiotics.

    Michael Smith, MD, Navjyot Vidwan, MD, Yana Feygin, MS, John Myers, PhD and Charles Woods, MD, MS, FIDSA, FSHEA, FPIDS, University of Louisville, Louisville, KY

    Disclosures:

    M. Smith, None

    N. Vidwan, None

    Y. Feygin, None

    J. Myers, None

    C. Woods, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.