1593. Recurrent Antibiotic Prescriptions in the Kentucky Medicaid Population
Session: Poster Abstract Session: Stewardship: Pediatric Antimicrobial Stewardship
Friday, October 6, 2017
Room: Poster Hall CD
Background: Kentucky (KY) has the second highest prescription rate of antibiotics in the US. Prior studies based on anonymous pharmacy claims have been unable to determine whether this high rate is attributable to prescribing to a greater proportion of the population as compared to other states or to recurrent antibiotic use in a more limited group of children. We identified children with multiple antibiotic courses in a longitudinal cohort of children enrolled by KY Medicaid.

Methods: We reviewed pharmacy claims of children (age <20) covered by KY Medicaid from 10/1/2015 to 9/30/2016. Systemic antibacterials were identified using specific National Drug Codes. Sociodemographic characteristics of interest included age, sex, race and Medicaid region. Descriptive statistics were used to identify patient characteristics associated with recurrent courses of antibiotics. Linear regression was used to determine factors independently associated with the number of courses prescribed in a calendar year.

Results: 333, 965 children received 778,471 antibiotic prescriptions across the year (Median 2, IQR 1-3). Summary statistics for recurrent courses of antibiotics by sociodemographic characteristics are presented in the Table.

 

n

Median

Interquartile Range

Overall

333965

2

1-3

Sex

Male

157822

2

1-3

Female

176143

2

1-3

Age (years)

0-2

48995

2

1-4

3-9

144097

2

1-3

10-19

140873

2

1-3

Race

American Indian

228

1.5

1-2

Asian

1598

1

1-2

Black

24026

1

1-1

Native Hawaiian

152

1

1-2

Not provided

86112

2

1-3

Other

19951

2

1-4

White

201898

2

1-3

Medicaid Region

1

18164

2

1-3

2

30309

2

1-3

3

73264

1

1-3

4

48700

2

1-3

5

55019

2

1-3

6

21972

1

1-3

7

23239

2

1-3

8

62941

2

1-4

In the regression model being male, Asian, and older were independently associated with receiving fewer prescriptions (p<0.001). There was also geographic variability; children in region 8 were more likely have to more prescriptions (p<0.001) while children in regions 2, 3, 5 and 6 had fewer prescriptions (p<0.001).

Conclusion: Children enrolled in KY Medicaid received, on average, 2 antibiotic prescriptions a year. Geographic variability in the number of prescriptions persisted after adjusting for sociodemographic characteristics. This suggests there may be modifiable prescribing behaviors among practitioners across the state. Further research into parental and provider perceptions of antibiotics are needed, and should focus on region 8.

Michael Smith, MD, MSCE1, Navjyot Vidwan, MD2, John Myers, PhD MSPH2 and Charles Woods, MD, MS, FIDSA, FSHEA, FPIDS3, (1)Pediatric Infectious Diseases, University of Louisville, LOUISVILLE, KY, (2)University of Louisville, Louisville, KY, (3)Pediatrics, University of Louisville School of Medicine, Louisville, KY

Disclosures:

M. Smith, None

N. Vidwan, None

J. Myers, None

C. Woods, None

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