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Cumulative Antibiotic Exposure in the Pediatric Spina Bifida Population
Than S. Kyaw, MD, PhD1, Debbie Goldberg, MS
2, Lindsay Hampson, MD, MAS
2, Hillary Copp, MD, MS
2.
1Massachusetts General Brigham, Boston, MA, USA,
2University of California San Francisco, San Francisco, CA, USA.
BACKGROUND: Spina Bifida (SB) is a common congenital condition often requiring frequent antibiotic use, but cumulative antibiotic exposure in the pediatric SB population remains underexplored.
METHODS: This retrospective cohort study utilized MarketScan insurance claims data (2013 - 2021) to compare cumulative antibiotic exposure in SB patients (ages 0-17) with age-matched controls. Cohort selection criteria included a diagnosis of SB in cases with 5:1 age-matched controls. Infections linked to antibiotic use were categorized by organ systems.
RESULTS: The cohort of 11,478 SB cases and 50,852 controls included 47% males in the SB group and 50% in controls. SB patients had 1.4 times higher antibiotic use than controls (mean: 8.1 vs. 6.0 prescriptions; p < 0.0001) and 1.6 times higher repeat courses within one week (2.8 vs. 1.8; p < 0.0001). Among prescriptions, 95 - 96% were tied to documented infections. SB patients were more likely to receive antibiotics for urinary system infections (32% vs. 8%; p < 0.0001), while controls more frequently received antibiotics for upper respiratory infections (64% vs. 55%, p < 0.0001) and otitis media (32% vs. 29%, p < 0.0001). SB patients were prescribed sulfonamides and urinary anti-infectives more frequently while controls were prescribed penicillin, macrolide, and tetracycline more frequently (p < 0.0001). Antibiotics for SB patients were more commonly prescribed in non-urgent home care settings (18% vs. 2%; p < 0.0001), whereas controls more frequently received antibiotics in urgent care settings (5% vs. 1%; p < 0.0001).
CONCLUSIONS: Pediatric SB patients experience significantly higher antibiotic exposure, primarily for urologic infections, and are at increased risk for repeat dosing. Future work will evaluate variabilities in antibiotic utilization and identify improvement strategies.
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