From the Journals

ADHD, asthma Rxs up

Publish date: May 15, 2018
By
Andrew D. Bowser

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Implications uncertain for clinical practice, public policy

These thorough analyses of medication prescribing for children and adolescents are much needed, but are “frustrating” because definitive conclusions cannot be drawn because of inherent limitations of the serial, cross-sectional study design, Gary L. Freed, MD, MPH, said in an editorial.

The study by Hales et al. shows an overall decrease in prescription medication use in children and adolescents based on data from the 1999-2014 National Health and Examination Survey (NHANES). The study shows increased use of medications for asthma, ADHD, and contraception, and decreased use of antibiotics, antihistamines, and upper respiratory combination medications.

“Some of these trends likely signal potential improvements in the care of children, others may suggest little progress has been made, and yet others are difficult to interpret with certainty,” Dr. Freed wrote.

One finding that seems clear in the data, according to Dr. Freed, is a decrease in antibiotic use among children and adolescents, from 8% to 5% from the 1999-2002 to 2011-2014 time period. That likely reflects the success of efforts to decrease overuse of these agents in community settings.

On the other hand, the decreased use of antihistamines documented in this study may reflect the success of efforts to reduce overuse, or the fact that several prescription medications became approved for OTC use over the course of the study. NHANES does not include OTC drug data in its survey.

“It is unclear whether there was simply a substitution effect and the actual overall rate of utilization of these medications was unchanged,” Dr. Freed wrote.

Increased amphetamine use for the treatment of children aged 6-11 years with ADHD is “vexing” to see, but again, caution must be exercised in interpreting the results, he said, because they do not clearly demonstrate whether these agents are being overused or underused.

“The findings reported by Hales et al. will require additional studies, using different data sources, to provide clarity in the clinical and policy implications of recent trends in medication use among children,” Dr. Freed wrote.

Dr. Freed is a pediatrician with the Child Health Evaluation and Research Center, University of Michigan, Ann Arbor. These comments are derived from his editorial accompanying the study by Hales et al. (JAMA. 2018;319[19]:1988-9). Dr. Freed had no conflicts of interest.


 

FROM JAMA

Use of prescription medication overall decreased in children and adolescents over the past 15 years, but certain medication classes saw increases over that time period, according to a comprehensive analysis of cross-sectional, nationally representative survey data.

Reported use of any prescription medication in the past 30 days decreased from 25% during 1999-2002 to 22% during 2011-2014 (P = .04), according to the analysis based on data from 38,277 children and adolescents aged 0-19 years in the National Health and Nutrition Examination Survey (NHANES).

Pills spilling out of a bottle ClaudioVentrella/Thinkstock
That decrease in part reflected less prescribing of antibiotics, antihistamines, and upper respiratory drugs, according to a report on the study in JAMA.

However, the study showed increases over time in prescribing of medications for asthma, ADHD, and contraception, according to Craig M. Hales, MD, of the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md., and his coinvestigators.

“Monitoring trends in use of prescription medications among children and adolescents provides insights on several important public health concerns, such as shifting disease burden, changes in access to health care and medicines, increases in the adoption of appropriate therapies, and decreases in use of inappropriate or ineffective treatments,” Dr. Hales and his coauthors said.

They found significant linear trends in 14 therapeutic classes or subclasses, including six decreases and eight increases, when looking at combined survey data for reported use of any prescription medication and reported use of two or more prescription medications in the prior 30 days.

Of note, antibiotic usage decreased significantly from 8% during 1999-2002 to 5% during 2011-2014, including decreases in amoxicillin, amoxicillin/clavulanate, and cephalosporins. Likewise, antihistamine use was down over time, from 4% to 2%, as was use of upper respiratory combination medications, which decreased from 2% to 0.5%.

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