Journal
PEDIATRICS
Volume 140, Issue 3, Pages -Publisher
AMER ACAD PEDIATRICS
DOI: 10.1542/peds.2017-0441
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Funding
- Eunice Kennedy Shriver National Institute of Child Health and Human Development [T32 HD052468-05]
- National Service Research Award Postdoctoral Traineeship from the Agency for Healthcare Research and Quality - Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill [5T32 HS000032-28]
- Graduate School at the University of North Carolina at Chapel Hill
- Center for Pharmacoepidemiology from GlaxoSmithKline
- UCB BioSciences
- Merck
- Agency for Healthcare Research and Quality
- National Institutes of Health (NIH)
- Department of Epidemiology at the University of North Carolina at Chapel Hill
- Gillings School of Public Health at the University of North Carolina at Chapel Hill
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OBJECTIVES: We examined 2 birth cohort effects on antibiotic prescribing during the first year of life (henceforth, infancy) in Denmark: (1) the birth season effect on timing and overall occurrence of antibiotic prescribing, and (2) the birth year effect amid emerging nationwide pneumococcal vaccination programs and changing prescribing guidelines. METHODS: We linked data for all live births in Denmark from 2004 to 2012 (N = 561 729) across the National Health Service Prescription Database, Medical Birth Registry, and Civil Registration System. Across birth season and birth year cohorts, we estimated 1-year risk, rate, and burden of redeemed antibiotic prescriptions during infancy. We used interrupted time series methods to assess prescribing trends across birth year cohorts. Graphical displays of all birth cohort effect data are included. RESULTS: The 1-year risk of having at least 1 redeemed antibiotic prescription during infancy was 39.5% (99% confidence interval [CI]: 39.3% to 39.6%). The hazard of a first prescription increased with age throughout infancy and varied by season; subsequently, Kaplan-Meier-derived risk functions varied by birth season cohort. After rollout of a first vaccination program and new antibiotic prescribing guidelines, 1-year risk decreased by 4.4% over 14 months (99% CI: 3.4% to 5.5%); it decreased again after rollout of a second vaccination program by 6.9% over 3 years (99% CI: 4.4% to 9.3%). CONCLUSIONS: In Denmark, birth season and birth year cohort effects influenced timing and risk of antibiotic prescribing during infancy. Future studies of antibiotic stewardship, effectiveness, and safety in children should consider these cohort effects, which may render some children inherently more susceptible than others to downstream antibiotic effects.
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