Decreased Prescriptions for Children during the Pandemic: Understanding Trends and Implications

Study finds decreases in prescription medications dispensed to children during COVID-19, including medications linked to infections and some used for chronic illnesses

Medicine University of Michigan

As children visited health centers less and participated in social distancing and other COVID-19 mitigation measures, fewer of them also received prescription medications, a new study suggests.

Overall, medications prescribed for children fell by more than a quarter during the first eight months of the pandemic compared to the previous year, with the steepest declines in infection-related medications such as antibiotics and cough and cough medications. a cold.

Dispensing of antibiotics to children and adolescents fell by almost 56% between April and December 2020 compared to the same period in 2019. Researchers also found decreases in prescriptions for chronic diseases, such as attention deficit disorder with hyperactivity disorder (ADHD) and asthma, but there were no changes in antidepressant prescriptions, according to findings published in Pediatrics .

"The decline in the number of children receiving antibiotics is consistent with large declines in infection-related pediatric visits during 2020," said lead author Kao-Ping Chua, M.D., Ph.D., a pediatrician and health researcher. from the University of Michigan CS Mott Children’s Hospital and Susan B. Meister Child Health Evaluation and Research Center.

"Because antibiotics have significant side effects, the dramatic decrease in antibiotic dispensing may be a positive development," he added. "However, the decline in the distribution of drugs for chronic diseases could be worrying."

Dispensing of infection-related medications decreased dramatically

Researchers analyzed national prescription dispensing data from 92% of U.S. pharmacies to evaluate changes in dispensing to children ages 0 to 19 during COVID-19.

Between January 2018 and February 2020, nearly 25.8 million prescriptions were dispensed to children per month. Dispensing totals during the first 8 months of the pandemic were down by approximately 27% compared to the same period in 2019.

Overall, medications typically prescribed for acute infections, including antibiotics, decreased nearly 51%, while those for chronic diseases decreased 17%.

"The decline in antibiotic dispensing likely reflects reductions in infections, such as colds and strep throat, due to COVID-19 risk mitigation measures such as social distancing and masks," Chua said.

"As a result, children had fewer infection-related visits and had fewer opportunities to receive antibiotic prescriptions, either for conditions appropriate for antibiotics or conditions inappropriate for antibiotics."

Chua’s previous research has suggested that nearly a quarter of antibiotic prescriptions among children and adults may be unnecessary. In children, antibiotics are the leading cause of emergency room visits for adverse drug events, with potential side effects including allergic reactions, fungal infections, and diarrhea.

Long-term overuse of antibiotics can also contribute to the development of antibiotic-resistant bacteria, causing diseases that were previously easily treatable with antibiotics to become untreatable and dangerous, Chua said.

Another welcome development in drug dispensing trends, the researchers found, was a decline in medications prescribed to treat common cold symptoms , particularly to suppress coughs. The findings suggest a nearly 80% drop in these medications (known as antitussive medications) during the 2020 study period.

"These medications have few benefits, but are associated with potentially harmful side effects, particularly in young children," Chua said. "From a healthcare quality perspective, the sharp decline in the distribution of cough and cold medications may represent a silver lining of the COVID-19 pandemic."

While the distribution of infection-related medications to children could recover as social distancing measures are lifted and infections rise, it still may not necessarily return to pre-pandemic levels soon, Chua said. If COVID-19 risk mitigation measures continue in schools and daycares, for example, this may reduce the incidence of conditions for which antibiotics are frequently prescribed, such as ear infections, sinusitis, and upper respiratory infections. . 
Dispensing medications for chronic diseases

The study found a modest 11% decrease in the dispensing of prescriptions for ADHD.

"Whether this decline is worrying needs to be further studied," Chua said. "For example, it is unclear whether the decline in ADHD prescriptions reflects a reduced need for medications at school due to the transition to remote learning, disruptions in access to medications, or delays in diagnosis."

There were also large declines in the dispensing of asthma medications, such as albuterol and inhaled steroids, according to the research.

National data suggests that the number of asthma attacks in children has dropped dramatically during the pandemic, Chua said. Given this, the decrease in medication dispensing likely reflects better asthma control.

Researchers need more data to better understand the lack of change in dispensing antidepressants to children during the pandemic. "An optimistic view is that few children on established antidepressant regimens discontinued their use," Chua said.

"Studies, however, suggest that children’s mental health has worsened during the pandemic, particularly among adolescents. Given this, our findings could suggest that antidepressant dispensing has not increased to meet this increased need."

Doctors can use electronic medical records to identify decreases in the frequency of refill requests among children on established medication regimens for chronic illnesses, Chua said. Doctors could then call families to determine if there is cause for concern, such as the medications being unaffordable for them, or if the changes reflect better disease control.

Dispensing totals decreased more dramatically for prescriptions paid with cash than for other payer types. Chua believes this finding suggests that uninsured children faced greater financial barriers to accessing health care and prescription medications during the pandemic.

The decline in dispensing in children is consistent with the decline in the total number of prescriptions dispensed to American adults, which declined sharply during the pandemic but then rebounded. However, the study indicates that distribution to children has not recovered to the same degree, Chua said.

"This study provides a national picture of prescription drug dispensing to children before and during the pandemic," he said. "It will be important to monitor whether the reductions we demonstrate are temporary or sustained."