Background: Antibiotic overuse is common among pediatricians. Since PCV reduces respiratory infections, a resultant reduction in antibiotic consumption was expected. We speculated that the decline in dispensed antibiotic prescription (DAP) rates will be greater among high antibiotic user clinics (HUC) than low user clinics (LUC).
Methods: Southern Israel is inhabited by two ethnic groups: Bedouins and Jews. Pre-PCV, DAP rates were higher in Bedouin children. In 2005-2009, yearly average of 10,002 Bedouin and 8,977 Jewish children <2y were insured by Clalit Health Maintenance Organization, where all prescriptions are computerized. Active clinics during both pre- and post-PCV periods with ≥50 insured children < 2y were enrolled. Mixed Bedouin/Jewish clinics (14% of children) were excluded. DAP rates were calculated by age, antibiotic category and ethnicity. Clinics were classified as HUC (above median DAP rates) and LUC (below median rates). During 2009-2016, 137,663 and 59,606 prescriptions were dispensed in HUC and LUC resp. among the Jewish children and 214,524 and 91,236 resp., among Bedouin children. PCV7/PCV13 were implemented in Jul 2009/Nov 2010 and rapidly reached ≥90% coverage.
Results: Proportion of dispensed antibiotics pre-PCV implementation is shown in Figure 1. Mean (/1000 child year ±SD) DAP rates during pre PCV implementation were 3246±156 and 2136±11 in Bedouin and Jewish children resp. The respective figures in HUC and LUC were 4033±163 and 2172±205 in Bedouin children; and 2589±33 and 1417±51 in Jewish children (P<.001). Pre-PCV, no significant trends in DAP rates were observed, but the rates rapidly declined post PCV in HUC in both ethnic groups. The reduction was greater in HUC than LUC, and no decrease was seen in LUC for Jewish children (Figure 2). Similar trends were found with amoxicillin, the commonest dispensed antibiotic. No decline in azithromycin was seen in HUC, and a significant increase was found in LUC, in both ethnic groups.
Conclusion: PCV7/PCV13 implementation was associated with a significant decline of DAP rates except in LUC among Jewish children, resulting in partial closing of the gap between HUC and LUC. Similar trends were found in both ethnic groups despite significant differences in the pre PCV DAP rates.
S. Ben-Shimol, Pfizer: Grant Investigator and Speaker's Bureau , Research grant and Speaker honorarium .
D. Greenberg, Pfizer: Consultant and Speaker's Bureau , Consulting fee and Speaker honorarium .
R. Dagan, Pfizer: Consultant , Grant Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Grant recipient , Research grant and Speaker honorarium . MeMed: Consultant , Consulting fee . MSD: Consultant , Grant Investigator and Scientific Advisor , Consulting fee and Research grant .