Antibiotic Utilization in Medicaid-Enrolled Children: Associations with Medical Complexity.

Abstract

To describe contemporary patterns of pediatric outpatient antibiotic utilization and to identify patient-level factors associated with high antibiotic use. We conducted a retrospective cohort study of outpatient antibiotic prescription claims using the Merative MarketScan Medicaid Database. We included children aged 0-18 years continuously enrolled in Medicaid from 1/1/2023 to 12/31/2023. Outcomes included 1) annual outpatient antibiotic prescription fill rates per 1,000 persons and 2) high antibiotic utilization, defined as >50 antibiotic days per year. Multivariable logistic regression assessed associations between covariates (patient demographics, insurance features and clinical complexity) and high antibiotic utilization. Among 2,357,642 Medicaid-enrolled children, 921,350 (39.1%) filled > 1 antibiotic prescription in 2023. Antibiotic prescription rates increased with medical complexity (P<.001) from 514 (95% CI: 513 - 516) per 1,000 persons in children without chronic conditions to 2,882 (95% CI: 2850 - 2915) in children with ≥3 complex chronic conditions (CCCs). Penicillins, cephalosporins, and macrolides comprised 93.0% of antibiotic prescriptions in healthy children, vs 65.0% in children with ≥3 CCCs. High antibiotic utilization was associated with younger age, female sex, blind/disabled basis of Medicaid eligibility, capitated plans, and increasing CCCs. Children with multiple CCCs have substantially higher antibiotic exposure and greater use of broad-spectrum antibiotics. These children may be an underrecognized target population for antibiotic stewardship interventions.