25 Aug Antibiotics Leading Cause of Pediatric Adverse Drug Events in ER

MedicalResearch.com Interview with:
Maribeth C. Lovegrove, MPH
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention
Atlanta, GA 30333).

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been a lot of recent attention on reducing unnecessary antibiotic prescribing in order to reduce antibiotic resistance (a longer-term harm).  However, antibiotic use also can lead to shorter-term harms like allergic reactions and other side effects.  With this analysis, we wanted to focus on the acute harms to individual pediatric patients from antibiotic use in order to help target prevention efforts.  Specifically, we used data from two national data sources to identify the antibiotics with the highest numbers of emergency department visits for adverse drug events and the highest rates of emergency department visits for adverse drug events (accounting for amount of antibiotic prescriptions dispensed) and to identify the pediatric patients with the highest risks.

MedicalResearch.com: What should readers take away from your report?

Response: Antibiotics are the leading cause of emergency department visits for adverse drug events in children, and led to nearly 70,000 estimated emergency department visits in children aged ≤19 years each year from 2011-2015.

• Two-fifths (41%) of these emergency department visits for an antibiotic adverse drug event involved a child aged ≤2 years.
• Each year, nearly 1 in 400 children aged ≤2 years are brought to an emergency department for an antibiotic adverse drug event.
• Most emergency department visits for antibiotic adverse drug events in children (86%) involved allergic reactions (e.g., rash, pruritus, angioedema).
• Since allergic reactions are largely non-preventable, minimizing unnecessary antibiotic use is the best way to reduce risks of antibiotic adverse drug events for individual patients.

Accounting for dispensed prescriptions, rates of emergency department visits for antibiotic adverse drug events declined with increasing age for all antibiotics except sulfamethoxazole-trimethoprim.

• The rate of emergency department visits for amoxicillin adverse drug events was 4 times higher for the youngest children (aged ≤2 years) than for the oldest children (aged 10–19 years).
• Each year, there was 1 emergency department visit by a child aged ≤2 years for an amoxicillin adverse drug event for every 330 amoxicillin prescriptions dispensed.
• Quantifying the risks of antibiotic adverse drug events can help clinicians and parents/caregivers weigh the risks and benefits of antibiotic treatment. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: In this study, we could not determine which of the antibiotic prescriptions were unnecessary or inappropriate because we did not have data on indication, dose, or duration of therapy.  However, there may be different rates of emergency department visits for adverse events for antibiotics prescribed for different indications, since the dose or duration of therapy may differ.  Future studies could assess rates of antibiotic adverse events by indication, dose, or duration of therapy.

Also, as efforts to improve antibiotic prescribing continue and gain momentum, we would expect that antibiotic adverse drug events would decline. We will continue to use these national data on emergency department visits for antibiotic adverse drug events to monitor progress.

MedicalResearch.com: Is there anything else you would like to add?

Response: This study likely underestimates the frequency of adverse drug events from antibiotic use, because only the adverse events that are treated and diagnosed in the emergency department setting were studied.  Antibiotic adverse events treated in other settings (e.g., urgent care, physician’s office), or in which no healthcare treatment was sought are not included.  Also, adverse events that are less likely to be diagnosed in the emergency department setting are not reliably included (e.g., Clostridium difficileinfection).  

Citation:

Maribeth C Lovegrove, Andrew I Geller, Katherine E Fleming-Dutra, Nadine Shehab, Mathew R P Sapiano, Daniel S Budnitz. US Emergency Department Visits for Adverse Drug Events From Antibiotics in Children, 2011–2015. Journal of the Pediatric Infectious Diseases Society, 2018; DOI: 10.1093/jpids/piy066

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Last Updated on August 25, 2018 by Marie Benz MD FAAD