Cumulative Antibiotic Exposure in Children With Spina Bifida.

Abstract

Spina bifida (SB) is a common congenital condition associated with frequent antibiotic use, but cumulative antibiotic exposure in the pediatric SB population remains underexplored. To test our hypothesis that the pediatric SB population has higher cumulative antibiotic exposure because of genitourinary (GU) infections, we will (1) quantify total antibiotic burden by age, (2) assess diagnoses associated with antibiotic prescriptions, and (3) identify differences in prescribing patterns, particularly for GU infections. This retrospective cohort study used MarketScan Commercial Claims data (January 2013-December 2021) to compare antibiotic utilization among patients with SB (age 0-17 years) in the United States and age-matched controls (3:1 ratio). Diagnoses linked to prescriptions were categorized by organ system, and cross-sectional and longitudinal trends were analyzed. The cohort included 13,782 SB cases and 60,301 controls. Patients with SB received 1.4 times more antibiotic prescriptions than controls (mean: 8.2 vs 6.0 prescriptions; 95% CI [2.0-2.5]; <i>P</i> < .0001), averaging 57 prescriptions by adulthood compared with 39 in controls (mean difference 18; 95% CI [17.9-18.8]; <i>P</i> < .0001); they also had significantly more days of antibiotic exposure (125 vs 69 days; 95% CI [50.9-61.4]; <i>P</i> < .0001), confirmed by longitudinal analysis. Nearly all prescriptions (95-96%) were linked to documented infections. Patients with SB were more frequently treated for genitourinary (GU) infection (32% vs 8%), gastrointestinal infection (15% vs 7%), and neurological infection (5.4% vs 0.2%), whereas controls more often received antibiotics for upper respiratory infections (URIs, 64% vs 55%) and otitis media (32% vs 29%). Patients with SB were often prescribed sulfonamides and urinary anti-infectives (<i>P</i> < .001). Although patients with SB were treated similarly to controls for URIs and ear infections (<i>P</i> > .05), they were prescribed significantly longer courses of antibiotics for GU care with extended and repeat regimens, likely prophylactic. Pediatric patients with SB experience significantly higher antibiotic exposure, primarily driven by prolonged treatment for GU-related conditions, despite otherwise similar management of common infections. Future work will examine the patterns and necessity of such prolonged regimens.