In the Journals

Antibiotics ‘leading cause’ of ED visits for adverse drug events in children

Photo of Katherine Fleming-Dutra
Katherine Fleming-Dutra

Children aged younger than 2 years made up a large percentage of ED visits for antibiotic adverse drug events, or ADEs, according to study results published in the Journal of the Pediatric Infectious Diseases Society.

“Antibiotic use can lead to antibiotic resistance and shorter term harms like allergic reactions and other side effects,” Katherine Fleming-Dutra, MD, deputy director of the Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, CDC, told Infectious Diseases in Children. “With this analysis, we wanted to focus on the short-term harms to individual pediatric patients from antibiotic use in order to help target prevention efforts. We found that antibiotics are the leading cause of [ED] visits for adverse drug events in children, and led to nearly 70,000 estimated [ED] visits annually in children aged 19 years and younger in the United States.”

Fleming-Dutra and colleagues in the CDC used data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Events Surveillance project and retail pharmacy dispensing data from the Quantiles IMS National Prescription Audit to estimate ED visits for antibiotic ADEs and oral antibiotic prescriptions.

The researchers estimated that 69,464 ED visits (95% CI, 53,488-85,441) were made annually in the U.S. for antibiotic ADEs for children aged 19 years and younger between 2011 and 2015, based on 6,542 surveillance cases. Children aged 2 years and younger were admitted for 40.7% of ED visits for antibiotic ADEs, with 86.1% involving an allergic reaction. The researchers reported a four-times greater population rate of ED visits for antibiotic ADEs in children aged younger than 2 yeas compared with children aged 10 to 19 years (23.8 vs. 5.2 visits per 10,000 population).

In almost all pediatric ED visits for antibiotic ADEs (95.9%), a single class of oral antibiotics was implicated, with amoxicillin being the most commonly implicated antibiotic among children aged 9 years and younger.

The researchers reported that, except for sulfamethoxasole-trimethroprim, rates of ED visits decreased for antibiotic ADEs as children got older. In children aged 2 years and younger, amoxicillin caused the highest rate of ED visits for antibiotic ADEs (29.9 ED visits per 10,000 dispensed prescriptions), whereas among older children aged 10 to 19 years, sulfamethoxasole-trimethroprim resulted in the highest rate (24.2 ED visits per 10,000 dispensed prescriptions).

“For pediatricians, these findings are a reminder that antibiotic adverse drug events are common and can be clinically significant and consequential for their patients,” Fleming-Dutra said. “As with all medications, we must carefully weigh the risks and benefits of antibiotics before prescribing them and only use antibiotics when necessary, and when they are necessary, use them correctly.” by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.

Photo of Katherine Fleming-Dutra
Katherine Fleming-Dutra

Children aged younger than 2 years made up a large percentage of ED visits for antibiotic adverse drug events, or ADEs, according to study results published in the Journal of the Pediatric Infectious Diseases Society.

“Antibiotic use can lead to antibiotic resistance and shorter term harms like allergic reactions and other side effects,” Katherine Fleming-Dutra, MD, deputy director of the Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, CDC, told Infectious Diseases in Children. “With this analysis, we wanted to focus on the short-term harms to individual pediatric patients from antibiotic use in order to help target prevention efforts. We found that antibiotics are the leading cause of [ED] visits for adverse drug events in children, and led to nearly 70,000 estimated [ED] visits annually in children aged 19 years and younger in the United States.”

Fleming-Dutra and colleagues in the CDC used data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Events Surveillance project and retail pharmacy dispensing data from the Quantiles IMS National Prescription Audit to estimate ED visits for antibiotic ADEs and oral antibiotic prescriptions.

The researchers estimated that 69,464 ED visits (95% CI, 53,488-85,441) were made annually in the U.S. for antibiotic ADEs for children aged 19 years and younger between 2011 and 2015, based on 6,542 surveillance cases. Children aged 2 years and younger were admitted for 40.7% of ED visits for antibiotic ADEs, with 86.1% involving an allergic reaction. The researchers reported a four-times greater population rate of ED visits for antibiotic ADEs in children aged younger than 2 yeas compared with children aged 10 to 19 years (23.8 vs. 5.2 visits per 10,000 population).

In almost all pediatric ED visits for antibiotic ADEs (95.9%), a single class of oral antibiotics was implicated, with amoxicillin being the most commonly implicated antibiotic among children aged 9 years and younger.

The researchers reported that, except for sulfamethoxasole-trimethroprim, rates of ED visits decreased for antibiotic ADEs as children got older. In children aged 2 years and younger, amoxicillin caused the highest rate of ED visits for antibiotic ADEs (29.9 ED visits per 10,000 dispensed prescriptions), whereas among older children aged 10 to 19 years, sulfamethoxasole-trimethroprim resulted in the highest rate (24.2 ED visits per 10,000 dispensed prescriptions).

“For pediatricians, these findings are a reminder that antibiotic adverse drug events are common and can be clinically significant and consequential for their patients,” Fleming-Dutra said. “As with all medications, we must carefully weigh the risks and benefits of antibiotics before prescribing them and only use antibiotics when necessary, and when they are necessary, use them correctly.” by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.