Association between high-intensity antibiotic prescribing and prescribing of psychotropic drugs in children: a population-based study

Background — Studies among adults have found that physicians who are high antibiotic prescribers are also high prescribers of other medications that are frequently overprescribed or prescribed inappropriately. The extent to which these findings generalise to prescribing for paediatric populations is unknown.

Methods — Population-based cohort study, Ontario, Canada, involving child-physician pairs with ≥1 primary care visit, 2018–2019. We used multivariable, hierarchical logistic regression to determine the association between high-intensity antibiotic prescribing and prescribing of stimulants, antidepressants, antipsychotics or all three drug classes, adjusting for child characteristics and clustering of child-physician pairs within physicians.

Results — 2 531 392 visits were included (834 565 children, 10 286 physicians). Psychotropic drug, stimulant and antidepressant prescribing was lower among high antibiotic prescribers versus average/low-intensity prescribers (adjusted OR (aOR) 0.66 (95% CI 0.62 to 0.71), 0.67 (95% CI 0.62 to 0.72) and 0.79 (95% CI 0.70 to 0.89), respectively). There was no association between the odds of a physician prescribing an antipsychotic and high-intensity antibiotic prescribing (aOR 0.95 (95% CI 0.84 to 1.08)). The inverse association between prescribing of psychotropic drugs and high-intensity antibiotic prescribing was stronger for visits with children with high continuity of care versus average/low continuity of care (aOR 0.42 (95% CI 0.34 to 0.52) vs aOR 0.72 (95% CI 0.66 to 78)), visits with children’s rostered versus non-rostered primary care physicians (aOR 0.54 (95% CI 0.48 to 0.59) vs aOR 0.74 (95% CI 0.68 to 0.81)) and visits with physicians remunerated under a fee-for-service versus salaried/capitation-based models (aOR 0.63 (95% CI 0.56 to 0.70) vs aOR 0.86 (95% CI 0.77 to 0.97)).

Conclusions — High antibiotic prescribing was generally associated with a lower propensity to prescribe psychotropic drugs among children. Our findings suggest the need for tailored approaches to paediatric drug stewardship across different classes of drugs.