TOPLINE

Children with three or more complex chronic conditions had higher odds of having at least 50 days of filled antibiotic prescriptions than healthy peers.

METHODOLOGY

• Researchers conducted a retrospective cohort study using an administrative claims database including more than 2.3 million children (49% girls) across 11 US states in 2023.
• Patients were categorized on the basis of medical complexity: healthy children with no chronic conditions (46.6%); children with a noncomplex chronic condition (46.7%); and children with one (5.4%), two (0.9%), or three or more (0.4%) complex chronic conditions.
• The primary outcome was rates of annual antibiotic prescriptions per 1000 persons; the secondary outcome was high antibiotic utilization, which was defined as at least 50 total days of antibiotic prescriptions filled by the patient during the study year.
• Associations between patient demographics, insurance features, clinical complexity, and high antibiotic utilization were also assessed.

TAKEAWAY

• Rates of annual antibiotic prescriptions increased with medical complexity, from 514 per 1000 in healthy children to 2882 per 1000 in those with three or more complex conditions.
• Children with three or more complex conditions had 10.2-fold higher adjusted odds of high antibiotic utilization than healthy children.
• Other factors associated with high antibiotic use were younger age, female sex, and Medicaid eligibility based on being blind or disabled.
• Penicillins, cephalosporins, and macrolides made up 93% of prescriptions in healthy children but only 65% in children with three or more chronic conditions, who had markedly higher rates of sulfonamide, quinolone, and aminoglycoside use.
• Streptococcal sore throat and otitis media were the most common indications overall, although 10.9% of prescriptions had no identifiable indication.

IN PRACTICE

“The magnitude of a patient’s medical complexity may be a key factor motivating antibiotic use, rather than use of medical technology or presence of specific underlying medical conditions predisposing to infection risk,” the researchers of the study wrote.

SOURCE

The study was led by Kathleen D. Snow, MD, MPH, of the Division of General Pediatrics in the Department of Pediatrics at the Boston Children’s Hospital in Boston. It was published online on August 2, 2026, in The Journal of Pediatrics.

LIMITATIONS

The data source was limited to Medicaid-enrolled children. The study evaluated only outpatient antibiotic fill rates, not overall prescribing patterns, which might have led to the underestimation of total antibiotic exposure as children with medical complexity often have higher inpatient hospitalization rates. Data on antibiotic allergies were not included.

DISCLOSURES

The study received no external funding, and the authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.