A new study from Boston Children’s Hospital found that annual prescription rates increase nonlinearly as a child’s level of underlying medical complexity increases. Frequent use of antibiotics carries risks, including increased likelihood of antibiotic-related complications (such as C. difficile) and development of antibiotic resistance. The results of the study will be presented at the Pediatric Society of America (PAS) 2026 Conference, April 24-27 in Boston.
Overuse or misuse of antibiotics contributes to the growing global threat of antibiotic resistance. Children with medical complexity (CMC) are particularly susceptible to frequent infections, but knowledge regarding antibiotic use for this group is limited. This study found that children with three or more complex chronic conditions were more likely to receive 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.
“This national analysis of outpatient antibiotic prescription filling for children on Medicaid shows that antibiotic use is common, with more than one-third of children filling at least one antibiotic prescription in 2023,” said Kathleen D. Snow, M.D., instructor of pediatrics at Boston Children’s Hospital and lead author of the study.
Children with multiple complex chronic conditions had significantly higher rates of antibiotic prescription filling, greater annual antibiotic exposure, and more frequent use of broad-spectrum antibiotic classes than their healthy peers. These findings suggest that children with complex medical conditions may be a population with significant implications for future antibiotic stewardship efforts. ”
Dr. Kathleen D. Snow, Instructor in Pediatrics, Boston Children’s Hospital
A retrospective cohort study of outpatient antibiotic prescription claims was conducted using the multistate MarketScan Medicaid database. Children aged 0 to 18 years who were continuously enrolled in Medicaid in 2023 were categorized into five mutually exclusive categories of underlying medical complexity: healthy (no chronic conditions), uncomplicated chronic conditions (NC-C), and one, two, or three or more complex chronic conditions (CCC). Poisson regression was used to compare antibiotic filling rates per 1,000 people between groups.
Of the 2,357,642 children included in the analysis, 926,025 (39.3%) received at least one antibiotic prescription (annual antibiotic prescription fill rate 787 per 1,000 (95% CI: 786-788)). Annual antibiotic prescription fill rates per 1,000 people increased with higher levels of medical complexity (p<.001). This increased from 514 cases (95% CI: 513, 516) in healthy children to 2,882 cases (95% CI: 2850, 2915) in children with three or more CCCs. Antibiotic exposure by drug class varied by healthcare complexity category (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 3 or more CCCs were significantly more likely to be prescribed sulfonamides, quinolones, and aminoglycosides than other children.
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Pediatric Society (PAS) Conference
