Antibiotic Prescription Rates Soar for Medically Complex Children, Study Finds

A new study from Boston Children's Hospital reveals stark disparities in antibiotic use among Medicaid-enrolled children, with those facing multiple complex health conditions receiving antibiotics at more than five times the rate of their healthy peers.

"Children with multiple complex chronic conditions experienced markedly higher antibiotic prescription fill rates, greater annual antibiotic exposure, and more frequent use of broad-spectrum antibiotics."
— Lead author Kathleen D. Snow, MD

The Scope of the Study

The retrospective cohort analysis drew data from the multi-state MarketScan Medicaid Database, examining 2,357,642 children aged 0–18 who were continuously enrolled in Medicaid throughout 2023. Findings are scheduled for presentation at the Pediatric Academic Societies 2026 Meeting in Boston, April 24–27.

Key Findings at a Glance

Nearly 40% of all children filled at least one antibiotic prescription in 2023.

• Total children with at least one prescription: 926,025 (39.3%)

However, the frequency of use varied dramatically by medical complexity:

The gap is more than 5.6-fold.

A Shift Toward Stronger Antibiotics

The type of antibiotics prescribed also differed significantly between the two groups.

• Healthy children overwhelmingly received narrow-spectrum options: penicillins, cephalosporins, and macrolides accounted for 93% of all prescriptions.
• Children with multiple CCCs were far more likely to receive broad-spectrum antibiotics—including sulfonamides, quinolones, and aminoglycosides—classes typically reserved for more resistant or serious infections.

This pattern raises important questions about antibiotic stewardship in medically fragile populations.

Why This Matters

The findings highlight a critical intersection of pediatric medicine. While antibiotics remain essential for treating infections, overuse—especially of broad-spectrum agents—can drive antibiotic resistance, a growing global health threat.

For children with complex chronic conditions, the balance between necessary treatment and cautious prescribing is especially delicate. The study provides baseline data that could inform future guidelines tailored to this vulnerable group.