High Rate of ED Visits for Children Linked With Antibiotic Adverse Effects

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Prevention efforts could target pediatric patients with the highest frequencies and rates of ED visits for antibiotic ADEs.
Prevention efforts could target pediatric patients with the highest frequencies and rates of ED visits for antibiotic ADEs.

New research published in the Journal of the Pediatric Infectious Disease Society found that many antibiotic adverse drug events led to emergency department (ED) visits, particularly among young children, highlighting a need for better communication regarding the risks of overprescribing.

Data concerning emergency room visits for antibiotic adverse events in children were gathered from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and retail pharmacy dispensing data from QuintilesIMS from 2011 to 2015. The frequency and rates of visits were estimated on the basis of 6542 surveillance cases.

An estimated 69,464 ED visits (95% CI, 53,488-85,441) were made annually among children aged ≤19 years from 2011 to 2015. This accounted for 46.2% of ED visits for antibiotic adverse events resulting from systemic medication. Visits for antibiotic adverse events involved children aged 2 years or younger in 40.7% of cases, and 86.1% involved an allergic reaction. Amoxicillin was the most commonly implicated antibiotic in cases involving children ≤9 years old and resulted in the highest rate of ED visits for antibiotic adverse events among children aged ≤2 years. Sulfamethoxazole-trimethoprim resulted in the highest rate among children aged 10 to 19 years (29.9 and 24.2 ED visits per 10,000 dispensed prescriptions, respectively).

Using public health surveillance data does have limitations, such as a probable underestimation of the burden of adverse effects from outpatient antibiotic use, as only adverse events resulting in ED visits were accounted for. Also, antibiotic adverse events are less likely to be diagnosed in the ED setting, and misdiagnosis may also be common. In addition, it was not possible to determine which antibiotic prescriptions were appropriate or not.

Investigators concluded that "[a]ntibiotic [adverse events] lead to nearly 70,000 estimated pediatric ED visits each year in the United States," and that minimizing overprescribing is crucial for reducing this harm, as well as combatting antibiotic resistance. Future research better quantifying the risks for antibiotic adverse events would better allow parents and caregivers to assess the risks and allow prevention strategies to be directed at the most vulnerable groups.

Reference

Lovegrove MC, Geller AI, Fleming-Dutra KE, Shehab N, Sapiano MRP, Budnitz DS. US emergency department visits for adverse drug events from antibiotics in children, 2011-2015 [published online August 23, 2018]. J Pediatric Infect Dis Soc. doi: 10.1093/jpids/piy066

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