Antibiotic Utilization for Perianal Fistulizing Complications among Young Patients with Crohn's Disease.

Abstract

To characterize patterns of antibiotic use among children with Crohn's disease and perianal fistulizing complications (PFCs) via a large, national administrative database. Retrospective analysis of US administrative claims including patients ≤21 years with Crohn's disease diagnosed 2009-2018 and 5-years of continuous enrollment. We evaluated patient characteristics, medication dispensing, and disease outcomes. Multivariable negative binomial regression evaluated predictors of days of antibiotics dispensed. Five thousand two hundred seventy-seven patients were included, with median age 16.0 years at diagnosis (55% male, 77% commercial insurance, 61% White). In total 17% developed PFC during enrollment. Antibiotic dispensing was common, 83% had at least 1 antibiotic prescription. Patients with PFC had more antibiotic days (median 67 days, IQR 26-138) compared with those without PFC (median 27 days, IQR 10-63; P = .001). In an adjusted model, patients with PFC had 90% more antibiotic dispensing than those without PFC. PFCs are common and are associated with greatly increased antibiotic dispensing with 1 in 12 patients filling >20 prescriptions during the 4-year study period. The optimal use of antibiotics remains unclear, and their extensive use in this population emphasizes the need for evidence-based treatment strategies and approaches to antibiotic stewardship.