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.
