Antibiotic Prescription Rates in Children <24 Months Old Following PCV7/PCV13 Sequential Implementation

BACKGROUND: PCV7/PCV13 (PCV) implementation markedly impacted on acute respiratory infection rates in young children, and is thus expected to reduce antibiotic use. We conducted a community-wide study to determine the extent of antibiotic prescription rates (APRs) following PCV implementation. METHODS: The study was conducted from July 2005 through June 2016 among all Jewish children <24m, insured by the Clalit Health Maintenance Organization (HMO) in southern Israel (74% of all the region’s Jewish children; n = 8,483, 2005; n = 13,604, 2016). All dispensed prescriptions for oral antibiotics at the HMO were recorded and yearly APRs were calculated by antibiotic category. PCV7 and PCV13 were implemented in July 2009 and November 2010 respectively and rapidly reached 90% coverage for 3 doses. Epidemiological years were from July through June. RESULTS: Overall, high APRs were seen throughout the study. A total of 226,035 antibiotic prescriptions were dispensed. Overall annual APR means (per 1,000 ± SD) were 2068.9 ± 15.2 and 1841.1 ± 39.1 in 2005–2009 and 2013–2016, respectively (11% reduction; 95% CI 10–12%) (Figure 1). Amoxicillin, the most commonly prescribed antibiotic drug (60.8% of all prescriptions) was reduced by 14% (95% CI 13–15%) (Figure 2). Similar reductions were seen for oral cephalosporins and amoxicillin/clavulanate. However azithromycin increased continuously throughout the study. Calculation of linear trends before and after PCV implementation demonstrated a significant change in trends for amoxicillin, oral cephalosporin and total APRs, strongly suggesting a causative role of PCVs. PCV implementation resulted in an overall reduction of 45,320 prescriptions for a cohort of 100,000 children during their first 2 years of life (95% CI 41,512 to 49,007). CONCLUSION: A clear and significant change in all APR trends associated with PCV implementation was observed in children <24 months old with a baseline high APR. This resulted in a marked decline in antibiotic use. Continuous surveillance is needed to determine further trends, including those for specific antibiotic categories. DISCLOSURES: R. Dagan, Pfizer: Consultant, Grant Investigator, Investigator, Research Contractor, Scientific Advisor and Speaker’s Bureau, Consulting fee, Grant recipient, Research grant, Research support and Speaker honorarium; MSD: Consultant, Grant Investigator, Investigator, Research Contractor and Scientific Advisor, Consulting fee, Grant recipient, Research grant and Research support; Memed: Consultant, Consulting fee; S. Ben-Shimol, Pfizer: Speaker’s Bureau, Speaker honorarium; D. Greenberg, Pfizer: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium; MSD: Consultant, Grant Investigator, Investigator and Speaker’s Bureau, Consulting fee, Grant recipient, Research grant, Research support and Speaker honorarium