Report: Pediatric Antibiotic Prescriptions Sharply Dropped During Pandemic

A new study has found steep declines in prescription drugs dispensed to children during the COVID-19 pandemic, including infection-related medications and some treatments for chronic diseases, according to a press release from Michigan Medicine.

These findings reflect fewer visits to health facilities, social distancing, and other safety measures implemented during the pandemic. Overall, prescriptions for children dropped by more than 25% during the first 8 months of the pandemic, with sharp declines in infection-related medications such as antibiotics and cough-and-cold drugs.

“The decrease in antibiotic dispensing most likely reflects reductions in infections, such as colds and strep throat, due to COVID-19 risk-mitigation measures like social distancing and face masks,” said lead author Kao-Ping Chua, MD, PhD, a researcher at University of Michigan Health C.S. Mott Children’s Hospital, in the press release. “As a result, children had fewer infection-related visits and had fewer opportunities to receive antibiotic prescriptions, whether for antibiotic-appropriate conditions or antibiotic-inappropriate conditions.”

Investigators analyzed national prescription drug dispensing data from 92% of pharmacies in the United States to assess changes in dispensing trends for children ages 0 to 19. Between January 2018 and February 2020, they found that nearly 25.8 million prescriptions were dispensed to this age group each month. Dispensing totals during the first 8 months of the pandemic, however, dropped by approximately 27%.

Antibiotic dispensing alone decreased by nearly 56% between April and December 2020, compared with the same period in 2019. The research team also noted declines in prescriptions for chronic diseases, such as attention-deficit hyperactivity disorder (ADHD) and asthma, although there was no change in prescription for antidepressants.

“The decline in the number of children receiving antibiotics is consistent with the large decreases in infection-related pediatric visits during 2020,” Chua said. “Because antibiotics have important side effects, the dramatic decreases in antibiotic dispensing may be a welcome development. However, declines in dispensing of chronic disease drugs could be concerning.”

Earlier research has suggested that nearly 25% of antibiotic prescriptions among children and adults may be unnecessary, and they have significant risks for children. According to the press release, antibiotics are the leading cause of emergency department visits for adverse drug events and potential adverse effects could include allergic reactions, fungal infections, and diarrhea.

The researchers also found declines in prescription medicines to treat common cold symptoms and especially cough preventatives. The data suggested a nearly 80% drop in these prescriptions during the 2020 study period, according to the study.

“These drugs have little benefit but are associated with potentially harmful side effects, particularly in young children,” Chua said in the press release. “From the perspective of health care quality, the sharp decline in dispensing of cough-and-cold medications may represent a silver lining of the COVID-19 pandemic.”

Although prescriptions for infection-related drugs could rebound as social distancing and other safety measures are lifted, Chua said they might not return to pre-pandemic levels soon. If risk mitigation measures remain active in schools, for example, this may decrease the risk of conditions for which antibiotics are frequently prescribed, such as ear infections, sinusitis, and upper respiratory infections.

When analyzing dispensing trends for chronic illnesses, the researchers found a modest 11% decline in prescriptions for ADHD.

“Whether this decline is concerning needs to be studied further,” Chua said in the press release. “For example, it is unclear whether the decline in ADHD prescriptions reflect a reduced need for medications at school due to the transition to remote learning, disruptions in medication access, or delays in diagnosis.”

They also noted a large decline in the dispensing of asthma medications, such as albuterol and inhaled steroids. Based on national data suggesting that the number of asthma attacks in children has dropped sharply during the pandemic, Chua said these lower prescription levels likely reflect improved asthma control. However, he added that more research is needed in order to understand the lack of change in antidepressant prescriptions for children during the pandemic.

“An optimistic view is that few children on established antidepressant regimens discontinued use,” Chua said in the press release. “Studies, however, suggest that the mental health of children has worsened during the pandemic, particularly among adolescents. Given this, our findings might suggest that antidepressant dispensing has not risen to meet this increased need.”

Overall, Chua concluded that the decreased dispensing in children is consistent with decreases in the total number of prescriptions for adult Americans, which also declined sharply during the pandemic. However, the study also suggests that dispensing to children has not rebounded to the same degree that adult dispensing has.

“This study provides a national picture of prescription drug dispensing to children before and after the pandemic,” he said in the press release. “It will be important to monitor whether the reductions we demonstrate are temporary or sustained.”

REFERENCE

Mostafavi B. Antibiotic prescriptions for kids plummet during pandemic. Michigan Medicine; July 20, 2021. Accessed August 5, 2021. https://labblog.uofmhealth.org/rounds/antibiotic-prescriptions-for-kids-plummet-during-pandemic