Trends and demographic predictors of cefdinir use for common bacterial infections in children enrolled in Medicaid, 2016–2023

Abstract

Abstract Objectives: To determine trends and predictors of cefdinir use for common pediatric infections in the United States. Design: Retrospective cohort study, 2016–2023. Setting: U.S. outpatient encounters (ambulatory, emergency department, urgent care) included in the Medicaid MarketScan database. Patients: Children aged 0–18 years diagnosed with bacterial rhinosinusitis, pharyngitis, urinary tract infection (UTI), acute otitis media (AOM), or community-acquired pneumonia (CAP). Methods: We assessed cefdinir prescription rates by diagnosis and year, comparing to other commonly administered antibiotics. We used logistic regression to identify demographic predictors of cefdinir use. Results: Among 7,346,547 encounters, most common diagnoses were AOM (36.9%) and bacterial pharyngitis (36.2%). Patients were predominantly non-Hispanic White (53.0%), 1–5 years-old (41.1%), and seen in ambulatory settings (75.3%). Cefdinir was prescribed in 10.4% of encounters, ranking among the top prescribed antibiotics. After an initial increase, use declined post-2020 to 7.6%. In children 1–18 years-old, younger age was uniformly associated with higher odds of cefdinir prescription across all diagnoses. This pattern was inconsistent among infants <1 years-old across diagnoses but persisted for UTI, with ORs of 9.38 (95% CI, 8.91–9.88) for <1 years-old and 5.91 (95% CI, 5.76–6.06) for 1–5 years-old versus 15–18 years-old patients. NH Black patients and those seen in urgent care or the emergency department were less likely to receive cefdinir. Conclusions: Despite a small decline in use since 2020, cefdinir use remains substantial, especially among young children with UTI. Continued efforts to reduce inappropriate use and promote antibiotic stewardship are warranted.