1351 - Pediatric Antibioitic Use in the North Carolina Medicaid Population

Background: Antimicrobial resistance is increasing in the United States, with antibiotic use as the main driver.  The majority of antibiotic use occurs in the outpatient setting.  6 of the 7 highest prescribing states are located in the Appalachian region of the country.   Overall, the state of North Carolina (NC) has prescribing rates that are at the national average, but the geographic, patient and provider-level characteristics associated with antibiotic prescribing within the state are unknown.

Methods: We used NC Medicaid claims from 2013-2018 to identify oral antibiotics prescribed to children, defined as individuals < 21 years.  Antibiotics were identified using National Drug Codes.  Overall rates of antibiotic prescribing were reported as the number of prescriptions per 1000 children overall and stratified by age, sex, race/ethnicity and residence in a metropolitan area.  Provider characteristics and setting type were identified using existing variables in the Medicaid dataset.  A geographic information system was used to graphically depict rates of antibiotic use by county. 

Results: Rates of prescribing decreased from 724/1000 children in 2013 to 578/1000 children in 2018.  Across all study years there were differences in prescribing rates by sex, race/ethnicity, age and residence in a metropolitan area. (Table)  Prescriptions were more common in children who were younger (0-2), white non-Hispanic, female and living in non-metropolitan areas.  Prescribing rates were geographically heterogeneous, with the highest rates in the western mountain region and declining across a west to east gradient. (Figure)  Most (62%) antibiotic prescriptions were written in the primary care setting.  Pediatricians prescribed 48% of all antibiotic courses.Antibiotic Prescriptions Per 1000 Children, by Demographic Group (2013-2018)
Antibiotic Prescriptions per 1000 Children, by County (2013-2018)


Conclusion: Although NC is not a high-prescribing state in general, we found notable difference in prescribing based on key demographic characteristics.  These results are consistent with prior reports from other Appalachian states including Kentucky, West Virginia and Tennessee.  Rates of prescription were highest in non-metropolitan areas overall but GIS mapping revealed a marked west-east gradient.  These data suggest that specific Appalachian characteristics, rather than rurality alone, may be associated with excessive antibiotic prescribing.