Unraveling the Impact of Pneumococcal Conjugate Vaccines on Ambulatory Antibiotic Drug Consumption in Young Children: An Interrupted Time-Series Analysis. (20th May 2021)

• Record Type: Journal Article
• Authors: Danino, Dana; van der Beek, Bart Adriaan; Givon-Lavi, Noga; Greenberg, David; Ben-Shimol, Shalom; Dagan, Ron
• Is Part Of: Clinical infectious diseases. Volume 73:Number 7(2021)
• Page Start: 1268
• Page End: 1278
• Publication Date: 2021-05-20
• Subjects: pneumococcal conjugate vaccines -- antibiotic consumption -- community -- children -- impact; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab413
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Pneumococcal conjugate vaccines (PCVs) reduce respiratory infections in young children, the main antibiotic consumers. Following PCV implementation, dispensed antibiotic prescription (DAP) rates in young children were expected to decline. Methods: Computerized data on DAP for children <5 years were examined during a 13-year period (including 4 pre-PCV years). All DAPs from clinics with ≥50 insured children, active both pre– and post–PCV implementation were included. Interrupted time-series with segmented regression was applied to analyze monthly DAP rate trends, adjusted for age, ethnicity, and season. Incidence rate ratios (IRRs) of DAPs during the late PCV13 period versus 4 years pre-PCV were calculated both as absolute rate ratios (aIRRs) and relative to expected rates (rIRRs). Results: Of 1 090 870 DAPs, 57% were in children <2 years. All-DAP rates peaked in the cold season. Post–PCV7/PCV13 implementation, all DAP rates abruptly and significantly declined, reaching a plateau within 5 years. This was largely driven by amoxicillin/amoxicillin-clavulanate (75% of DAPs). Age <2 years and Bedouin ethnicity were significantly associated with higher pre-PCV DAP rates but with faster and greater decline post-PCV, achieving near elimination of gaps between ages and ethnic groups. Overall reduction (95% CIs) in DAP rates per 1000 was estimated between aIRR (344.7 [370.9–358.4]) and rIRR (110.4 [96.9–123.7]) values. Conclusions: Shortly following PCV implementation, overall DAP rates showed an abrupt, steep decline, stabilizing within 5 years, in parallel to post-PCV respiratory infection trends previously described in this population, suggesting causality. The variable patterns of certain drug categories suggest additional influences beyond PCV. Abstract : Overall dispensed ambulatory antibiotic prescription rates rapidly declined in young children during the first 5 post–pneumococcal conjugate vaccine (PCV) implementation years, stabilizing thereafter. This was largely driven by amoxicillin/amoxicillin-clavulanate dynamics. Trends were parallel to the previously described post–PCV respiratory infection trends, suggesting causality.