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Community-wide interventions prove modestly successful in reducing antibiotic use among Medicaid-insured children

Much attention has been drawn to the threat to public health posed by high rates of antibiotic use. The rapid increase in antibiotic resistance among common bacterial pathogens is widely believed to be fueled by the high use of antibiotics, especially among young children. In order to reduce their antibiotic use and the use of broad-spectrum antibiotics that target several types of bacteria, the research team tested an educational intervention in 16 small and large towns. They conducted an educational program during three successive cold and flu seasons (2000-2003) in collaboration with three private insurers and a State Medicaid program.

The multifaceted intervention was aimed primarily at parents of children younger than 6 years and their physicians. The parents were sent an initial letter and brochure, followed by two newsletters each winter, and were provided access to a Web site. All physician practices in the intervention communities received a range of patient-education materials and information about antibiotic use rates and antibiotic resistance in the community.

There was a substantial downward trend in antibiotic prescribing, even in the absence of the educational program. The program had no additional effect among children aged 3 to less than 24 months of age, but was responsible for a 4.2 percent decrease in antibiotic prescribing among children from 24 to 48 months and a 6.7 percent decline among those from 48 to 72 months.

The only significant intervention effect experienced among privately insured children was a 5.1 percent decrease for those older than 4 years. However, Medicaid-insured children experienced modest decreases of 4.5 percent among those from 3 to 24 months of age, 5.5 percent among children from 24 to 48 months and 9.0 percent among children from 48 to 72 months. Medicaid-insured children are an important group, because they had higher baseline rates of antibiotic use. The intervention also significantly reduced the rate of increase in the use of broad-spectrum antibiotics (macrolides).

The study was supported by the Agency for Healthcare Research and Quality (HS10247).

See "Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts," by Jonathan A. Finkelstein, M.D., M.P.H., Susan S. Huang, M.D., M.P.H., Ken Kleinman, Sc.D., and others in Pediatrics 121(1), pp. 15-23, 2008.

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