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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nChildren with 3 or more complex conditions filled antibiotic prescriptions at 5 times the rate of healthy children.<\/li>\n Children with medical complexity were also 10 times more likely to have high antibiotic usage.<\/li>\n<\/ul>\nBOSTON \u2014 Children with multiple complex medical conditions receive more than 5 times the amount of antibiotics compared with healthy children and double that of the elderly, according to a large study.<\/p>\n
\u201cAntibiotics are the most commonly prescribed class of medications in children,\u201d Kathleen D. Snow, MD, MPH, <\/b>instructor of pediatrics at Boston Children’s Hospital, told attendees at the Pediatric Academic Societies annual meeting. \u201cUnfortunately, little research has been done to identify which specific patient populations are at the highest risk for antibiotic exposure.\u201d<\/p>\n
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Image: Adobe Stock.<\/i>
Snow and colleagues studied antibiotic prescription fill rates among 2,357,642 children enrolled in Medicaid in 11 states in 2023. They compared how many prescriptions \u2014 and which type of antibiotics \u2014 were dispensed to healthy children, children with a non-complex chronic condition and children with one or more complex chronic conditions.<\/p>\n
Overall, 2 in 5 children filled at least one antibiotic prescription (n = 926,025; 787 per 1,000 people). According to Snow, the percentage of children who received antibiotics rose proportionately with medical complexity, ranging from 30.9% in healthy children to 63.9% in children with three or more complex conditions. The annual fill rate per 1,000 people also rose with medical complexity from 514 (95% CI, 513-516) among healthy children to 2,882 (95% CI, 2,850-2,915) among children with multiple complex chronic conditions. <\/p>\n
\u201cThese children had greater than 5 times higher antibiotic fill rates compared with otherwise healthy children and more than double the antibiotic fill rates compared with the elderly, which is a population that has previously been thought to have the highest antibiotic utilization,\u201d Snow said during her presentation.<\/p>\n
Snow and colleagues also identified the proportion of children in each medical complexity category who were \u201chigh antibiotic utilizers,\u201d meaning they had 50 days of antibiotic exposure or more in 1 year. Compared with children who have no chronic conditions, the odds of high antibiotic usage were:<\/p>\n
\nmore than 2 1\/2 times higher (OR = 2.61; 95% CI, 2.54-2.67) for children with noncomplex chronic conditions;<\/li>\n nearly 4 times higher (OR = 3.67; 95% CI, 3.54-3.8) for kids with one complex chronic condition;<\/li>\n almost 6 times higher (OR = 5.61; 95% CI, 5.3-5.95) for two complex conditions; and <\/li>\n more than 10 times higher (OR = 10.22; 95% CI, 9.49-11) if the child had three or more complex conditions. <\/li>\n<\/ul>\n\u201cAs a practicing pediatrician, I was not surprised to see that children with medical complexity receive more prescriptions than their otherwise healthy peers,\u201d Snow told Healio. \u201cI was surprised to see the magnitude of difference in prescribing rates.\u201d<\/p>\n
According to the researchers, the median duration per prescription was 10 days across all groups. The most common drug type prescribed in all children were penicillins, cephalosporins and macrolides. Notably, these drugs comprise 93% of prescriptions among healthy children, but only 64% of children with three or more chronic conditions.<\/p>\n
\u201cThese children were much more likely to receive prescriptions for sulfonamides, quinolones and aminoglycosides, which are less commonly used antibiotics in pediatrics, cover a broad spectrum of infectious pathogens and have a different side effect profile,\u201d Snow said. <\/p>\n
She noted that future research should investigate how appropriate these antibiotic prescriptions were and what the outcomes are for children with high antibiotic utilization. Her team is currently conducting a pilot study to see how children with medical complexity respond to shorter antibiotic durations for pneumonia.<\/p>\n
For more information:<\/h2>\n Kathleen D. Snow, MD, MPH,<\/b> can be reached at kathleen.snow@childrens.harvard.edu.<\/p>\n\n
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Perspective<\/h2>\n Back to Top
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These findings are significant, though not entirely surprising. Prior studies have suggested that children with medical complexity or multiple chronic conditions receive more antibiotics overall, often driven by higher health care utilization, device dependence, and diagnostic uncertainty. However, much of the pediatric antibiotic literature, including some of my own prior work, has intentionally excluded children with substantial medical complexity to avoid biasing results, or has focused on aggregate measures of exposure in otherwise healthy children or singlecondition cohorts. This study addresses a longstanding gap by directly examining outpatient antibiotic use in this population at scale.<\/default:p>The findings closely align with clinical experience. Caring for children with multiple chronic conditions often involves profound diagnostic uncertainty: Baseline symptoms may be atypical, laboratory values difficult to interpret, and the consequences of missing a serious infection potentially severe. Not surprisingly, clinicians\u2019 fear of undertreatment lowers thresholds for prescribing antibiotics and favors repeated or broadspectrum use. Importantly, this study shows that antibiotic exposure in these children is not just higher in volume, but qualitatively different, with distinct and heterogeneous patterns.<\/default:p>Pediatricians can use these findings to rethink antibiotic stewardship for children with medical complexity. Stewardship strategies designed for otherwise healthy children may not translate directly to this population. Instead, care teams should focus on longitudinal patterns of exposure, subspecialty-driven prescribing, and cumulative risk, particularly given these children\u2019s heightened susceptibility to harms such as Clostridioides difficile<\/default:i> infection and adverse drug events. Applying stewardship principles thoughtfully, such as reassessing indications, minimizing duration when appropriate, and engaging subspecialists and families in shared decisionmaking, may help accomplish this difficult task.<\/default:p>I see the next steps in this research as possibly linking specific antibiotic exposure patterns to clinical outcomes. Understanding which patterns confer the greatest risk is essential for designing stewardship interventions that acknowledge diagnostic uncertainty while minimizing preventable harm.<\/default:p><\/p>\n\n
Rana E. El Feghaly, MD, MSCI, CPHQ, FPIDS<\/strong><\/p>\n\nDirector, Division of Infectious Diseases<\/li>\n Director, Quality and Safety<\/li>\n Children\u2019s Mercy Kansas City<\/li>\n<\/ul>\n<\/div>\n
Disclosures: <\/strong> El Feghaly reports that her institution receives grant funding from Merck for outpatient antibiotic prescription research.
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Sources\/Disclosures<\/h3>\n Source: <\/h2>\n Snow KD, et al. Medical Complexity and High Rates of Outpatient Antibiotic Exposure. Presented at: Pediatric Academic Societies Annual Meeting; April 24-27, 2026; Boston.<\/p>\n
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