PCVs (pneumococcal conjugate vaccines) decrease respiratory infections in young children, who are the primary consumers of antibiotics. The incidence of dispensed antibiotic prescriptions (DAP) in young children was projected to drop after PCV was implemented. Over a 13-year period, computerized data on DAP for children aged 5 years were analyzed (including 4 pre-PCV years). All DAPs from clinics with at least 50 insured children were included before and after PCV implementation. Monthly DAP rate trends were analyzed using an interrupted time series with segmented regression, which was balanced for age, ethnicity, and season. DAP incidence rate ratios (IRRs) were assessed as absolute rate ratios (aIRRs) and relative to predicted rates during the late PCV13 era against 4 years before PCV (rIRRs). 57% of the 10,90,870 DAPs were children under the age of 2. During the cold season, all-DAP rates peaked. All DAP rates dropped sharply and considerably once PCV7/PCV13 was used, eventually reaching a plateau after 5 years. Amoxicillin/amoxicillin-clavulanate was a significant contributor (75% of DAPs). Age 2 years and Bedouin ethnicity were both linked with higher pre-PCV DAP rates but a faster and greater drop post-PCV, resulting in differences between ages and ethnic groups being nearly eliminated. Between the aIRR (344.7 [370.9–358.4]) and rIRR (110.4 [96.9–123.7]) values, an overall reduction in DAP rates per 1,000 was predicted (95% CIs). Overall DAP rates dropped sharply after PCV deployment, stabilizing after 5 years, in keeping with post-PCV respiratory infection trends previously observed in this community, implying causation. However, the varying patterns of some drug categories show that there are other factors at work in addition to PCV.
Link:academic.oup.com/cid/article-abstract/73/7/1268/6278471?redirectedFrom=fulltext
