American children and teenagers used fewer medications that require a prescription, with any use decreasing from 24.6% to 21.9% between 1999 and 2014.
“Monitoring trends in use of prescription medications among children and adolescents provides insights on several important public health concerns, such as shifting disease burden, changes in access to health care and medicines, increases in the adoption of appropriate therapies and decreases in use of inappropriate or ineffective treatments,” Craig M. Hales, MD, from the National Center for Health Statistics at the CDC, and colleagues wrote. “Adverse drug events, particularly involving antibiotics, psychotropics, opioids, and cold and cough medications, are also a concern.”
To examine current trends in pediatric and adolescent prescription medication use, Hales and colleagues conducted an analysis of data collected in the National Health and Nutrition Examination Survey (NHANES) that focused on children between the ages of 0 and 19 years. This serial, cross-sectional, nationally representative survey was conducted between 1999 and 2014. All participants were classified as civilian and noninstitutionalized.
When investigating data, the researchers were made aware of the sex, age, race and Hispanic origin of participants. Additionally, Hales and colleagues were advised of the household income and education level, insurance status and current health status of the children included in the analysis. Specifically, the researchers determined the use of any prescription medications or two or more prescriptions taken in the past month, as well as the use of prescriptions by therapeutic class and trends in use within 4-year periods.
Of the 38,277 children and adolescents for which data were available (mean age, 10 years), 49% were female. Overall prescription medication use in the past 30 days decreased from 24.6% (1999-2002; 95% CI, 22.6%-26.6%) to 21.9% (2011-2014; 95% CI, 20.3%-23.6%) (beta = –0.41 percentage points every 2 years; 95% CI, –0.79 to –0.03). No linear trend was present in data regarding use of two or more prescription medications (8.5% [95% CI, 7.6-9.4] in 2011-2014).
Overall prescription medication use among American children and adolescents decreased between 1999 and 2014; however, increases were observed in asthma, ADHD and contraceptive medication use.
In the last years of the survey (2011-2014), the most commonly reported prescription medications used by children and adolescents included asthma medications (6.1%; 95% CI, 5.4-6.8%), antibiotics (4.5%; 95% CI, 3.7%-5.5%), ADHD medications (3.5%; 95% CI, 2.9%-4.2%), topical agents such as dermatological agents and nasal steroids (3.5%; 95% CI, 3.0%-4.1%) and antihistamines (2.0%; 95% CI, 1.7% to 2.5%).
Of the 39 classes and subclasses of medications assessed, eight — including asthma, ADHD and contraceptive medication — demonstrated linear increases. Decreases were observed in six classes and subclasses of medications, including antibiotics, antihistamines and upper respiratory combination medications.
“The effectiveness and safety of cough and cold medications have been called into question,” Hanes and colleagues wrote. “NHANES did not collect data on most over-the-counter medications. While certain upper respiratory combination medications, such as those containing codeine, could be obtained by prescription only, many formulations were available both by prescription and over the counter.”
“Moreover, certain antihistamines became available over the counter during the study period,” the researchers continued. “This study showed a marked decrease in the use of prescription upper respiratory combination medications and prescription antihistamines overall; decreases also occurred within each age category.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.