A new study from Boston Children’s Hospital found that annual prescription rates increased non-linearly as children’s underlying level of medical complexity increased. There are risks associated with frequent antibiotic use, including the potential for antibiotic-related complications (e.g., C. difficile) as well as the development of antibiotic resistance. The study findings will be presented during the Pediatric Academic Societies (PAS) 2026 meeting, taking place April 24-27 in Boston.
The overuse or misuse of antibiotics contributes to the growing global threat of antibiotic resistance. Children with medical complications (CMC) are particularly vulnerable to recurrent infections, yet knowledge of antibiotic use for this group is limited. This study found that children with three or more complex chronic conditions were more likely to fill prescriptions for broad-spectrum antibiotics with less favorable safety profiles. Children with three or more complex chronic conditions have the highest annual prescription rates of any population group (adult or pediatric). CMC is an important target population for future antibiotic stewardship efforts.
“In this national analysis of outpatient antibiotic prescription fills among Medicaid-enrolled children, we found that antibiotic use was common, with more than one-third of children filled at least one antibiotic prescription in 2023,” said Kathleen D. Snow, MD, professor of pediatrics at Boston Children’s Hospital and lead author of the study.
Children with multiple complex chronic conditions experienced markedly higher antibiotic prescription fill rates, greater annual antibiotic exposure, and more frequent use of broad-spectrum antibiotic drug classes than their healthy peers. “These findings suggest that children with medical complexity may be a high-impact population for future antibiotic stewardship efforts.”
Kathleen D. Snow, MD, instructor of pediatrics, Boston Children’s Hospital
A retrospective cohort study of outpatient antibiotic prescription claims was conducted using the multi-state MarketScan Medicaid database. Children ages 0 to 18 years of age continuously enrolled in Medicaid in 2023 were included and classified into five mutually exclusive categories of underlying medical complexity: healthy (no chronic conditions), non-complex chronic conditions (NC-C), and one, two, or three or more complex chronic conditions (CCC). Antibiotic fill rates per 1,000 persons were compared across groups using Poisson regression.
Of the 2,357,642 children included in the analysis, 926,025 (39.3%) filled ≥1 antibiotic prescription (annual antibiotic prescription fill rate of 787 per 1,000 persons (95% CI: 786–788)). The annual antibiotic prescription fill rate per 1,000 persons increased from 514 (95% CI: 513, 516) in healthy children to 2,882 (95% CI: 2850, 2915) in children with three or more CCCs with higher levels of medical complexity (P < .001). Antibiotic exposure varied by drug class across medical complexity categories (Figure 1). Penicillins, cephalosporins, and macrolides accounted for 93% of antibiotic prescriptions in healthy children, but only 64% of prescriptions in children with three or more CCCs. Children with three or more CCCs were given significantly more prescriptions for sulfonamides, quinolones, and aminoglycosides than their peers.
