TABLE 1.
Demographic and Clinical Characteristics by Treatment Group, Crude and Weighted
| Crude | Weighteda | ||||
|---|---|---|---|---|---|
| Fluoroquinolones (n = 275 767) | Comparatorsb (n = 7 365 684) | Standardized Mean Difference | Comparatorsb (n = 280 168) | Standardized Mean Difference | |
| Region, n (%)c | 0.038 | 0.004 | |||
| Northeast | 37 331 (13.5) | 977 952 (13.3) | — | 38 019 (13.6) | — |
| North central | 67 143 (24.3) | 1 890 835 (25.7) | — | 68 071 (24.3) | — |
| South | 129 936 (47.1) | 3 464 911 (47.0) | — | 132 236 (47.2) | — |
| West | 38 306 (13.9) | 959 147 (13.0) | — | 38 683 (13.8) | — |
| Unknown | 3051 (1.1) | 72 839 (1.0) | — | 3159 (1.1) | — |
| Sex, n (%) | −0.311 | 0.005 | |||
| Male | 84 950 (30.8) | 3 367 759 (45.7) | — | 85 689 (30.6) | — |
| Female | 190 817 (69.2) | 3 997 925(54.3) | — | 194 479 (69.4) | — |
| Age, y | 0.872 | 0.003 | |||
| Median (IQR) | 17 (16 to 18) | 15 (14 to 17) | — | 17 (16 to 18) | — |
| 12–13, n (%) | 13 256 (4.8) | 1 824 333 (24.8) | — | 13 329 (4.8) | — |
| 14–15, n (%) | 37 423 (13.6) | 1 995 660 (27.1) | — | 37 859 (13.5) | — |
| 16–17, n (%) | 109 504 (39.7) | 2 374 101 (32.2) | — | 111 416 (39.8) | — |
| 18, n (%) | 115 584 (41.9) | 1 171 590 (15.9) | — | 117 564 (42.0) | — |
| Indication, n (%) | |||||
| Diagnosis identifiedd | |||||
| Tier 1 | 87 876 (31.9) | 590 646 (8.0) | 0.625 | 93 322 (33.3) | −0.031 |
| Tier 2 | 62 273 (22.6) | 3 501 615 (47.5) | −0.542 | 61 500 (22.) | 0.015 |
| Tier 3 | 47 613 (17.3) | 1 781 506 (24.2) | −0.171 | 46 886 (16.7) | 0.014 |
| Diagnosis not identifiede | 78 005 (28.3) | 1 491 917 (20.3) | 0.145 | 78 459 (28.0) | 0.005 |
| Recent antibiotic, n (%)f | |||||
| Previous 14 d | 12 396 (4.5) | 236 531 (3.2) | 0.067 | 13 027 (4.6) | −0.007 |
| Previous 30 d | 21 814 (7.9) | 447 580 (6.1) | 0.072 | 22 747 (8.1) | −0.008 |
| Previous 100 d | 46 671 (16.9) | 1 049 909 (14.3) | 0.074 | 48 109 (17.2) | −0.007 |
| Recent corticosteroids, n (%)g | |||||
| Same day | 9334 (3.4) | 423 015 (5.7) | −0.113 | 9389 (3.4) | 0.002 |
| Previous 100 d | 10 847 (3.9) | 236 543 (3.2) | 0.039 | 11 327 (4.0) | −0.006 |
| Health care useh | |||||
| Count of outpatient encounters, median (IQR) | 3 (2 to 6) | 3 (2 to 5) | 0.088 | 3 (2 to 6) | −0.021 |
| Any inpatient admission, n (%) | 2930 (1.1) | 40 867 (0.6) | 0.057 | 3137 (1.1) | −0.006 |
| Comorbid conditions, n (%) | |||||
| Any complex chronic conditioni | 20 534 (7.4) | 400 659 (5.4) | 0.082 | 22 026 (7.9) | −0.016 |
| Neurologic or neuromuscular | 2152 (0.8) | 40 682 (0.6) | 0.028 | 2410 (0.9) | −0.009 |
| Cardiovascular | 2949 (1.1) | 64 971 (0.9) | 0.019 | 3051 (1.1) | −0.002 |
| Respiratory | 1530 (0.6) | 7445 (0.1) | 0.079 | 1867 (0.7) | −0.014 |
| Renal or urologic | 1372 (0.50 | 12 162 (0.2) | 0.058 | 1605 (0.6) | −0.010 |
| Gastrointestinal | 3629 (1.3) | 24 688 (0.3) | 0.109 | 4395 (1.6) | −0.021 |
| Hematologic or immunologic | 1279 (0.5) | 21 887 (0.3) | 0.027 | 1405 (0.5) | −0.005 |
| Metabolic | 3584 (1.3) | 71 998 (1.0) | 0.030 | 3761 (1.3) | −0.004 |
| Other congenital or genetic defect | 3410 (1.2) | 105 587 (1.4) | −0.017 | 3603 (1.3) | −0.004 |
| Malignancy | 4020 (1.5) | 93 256 (1.3) | 0.017 | 4087 (1.5) | <0.001 |
| Premature or neonatal | 24 (<0.1) | 611 (<0.1) | <0.001 | 26 (<0.1) | −0.001 |
| Transplantation | 213 (0.1) | 3704 (0.1) | 0.011 | 250 (0.1) | −0.004 |
| Device | 1105 (0.4) | 14 668 (0.2) | 0.037 | 1335 (0.5) | −0.011 |
IQR, interquartile range; —, not applicable.
SMR weighting: comparator-treated group weighted to covariate distribution of the fluoroquinolone-treated group.
Comparators: amoxicillin-clavulanate, azithromycin, cefalexin, cefdinir, cefixime, nitrofurantoin, and sulfamethoxazole-trimethoprim.
Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
Codes were obtained from any encounter up to the day of the index fill or 3 d before. Codes were classified by using diagnostic categories developed by Fleming-Dutra et al.36 Beneficiaries were only counted in the priority category (priority order: tier 1, tier 2, tier 3).
Either no recent codes were available (ie, the child did not have any health care encounters on the day of the antibiotic fill or in the 3 d before) or the diagnoses codes captured during that period were for an unrelated antibiotic or were nonspecific (E-codes and codes for symptoms, signs, or ill-defined health conditions). This category includes all other diagnosis codes that were not included in tier 3.
Any outpatient pharmacy prescription fill for a systemic antibiotic (Anatomical Therapeutic Chemical group J01).
Outpatient pharmacy prescription fill for systemic budesonide, triamcinolone hexacetonide, prednisone, prednisolone, methylprednisolone, dexamethasone, or hydrocortisone.
Captured during the 180 d before the index fill. Count of outpatient encounters is the count of unique service and discharge dates. The presence of any inpatient admission during 180 to 101 d before the index fill (exclusion criteria prohibited inpatient admission during the 100 d before).