Antibiotic Prescribing for Children—Where We Are Now

Overuse of antibiotics in the 1980s and 1990s led to a surge in antibiotic-resistant bacteria. Early research, including a series of papers in the Journal of the American Medical Association (2002), showed that U.S. doctors were beginning to reduce unnecessary prescriptions for children. That downward trend continued—but only for a while.

Today, antibiotic resistance remains a major public health challenge, and more recent studies show both progress and reasons for concern.

Prescribing did decrease… but then stalled

A 2016 CDC report analyzing outpatient prescribing between 2010–2011 found that:

  • Children under 2 receive more antibiotics than any other age group.

  • Up to 30% of all outpatient antibiotic prescriptions are unnecessary (e.g., given for viral infections).
    Source: CDC. “Antibiotic Use in the United States, 2017.” https://www.cdc.gov/antibiotic-use

Updated Article Section: Antibiotic Prescribing Trends & Resistance Risk

According to the study “Trends in Antimicrobial Prescribing Rates for Children and Adolescents” by Linda F. McCaig, Richard E. Besser, and James M. Hughes — published in JAMA on June 19, 2002 (Vol. 287, No. 23, pp. 3096-3102) — antimicrobial (antibiotic) prescribing for U.S. children under 15 years decreased substantially between 1989–1990 and 1999–2000. ResearchGate+1

Specifically:

  • The average annual number of antimicrobial prescriptions in physician offices dropped from 45.5 million in 1989–1990 to 30.3 million in 1999–2000. JAMA Network+1

  • The population-based rate (prescriptions per 1,000 children) fell from 838 (95% CI, 711–966) to 503 (95% CI, 419–588). PubMed

  • The visit-based rate (prescriptions per 1,000 office visits) declined from 330 (95% CI, 305–355) to 234 (95% CI, 210–257). ResearchGate+1

  • For the five common respiratory tract infections combined (otitis media, pharyngitis, bronchitis, sinusitis, upper respiratory infection), the population-based prescribing rate dropped from 674 to 379 per 1,000 children. PubMed+1

These reductions occurred despite relatively stable numbers of office visits, suggesting a real change in prescribing behavior rather than simply fewer visits. ResearchGate+1

The authors attribute this decline to increased awareness — by physicians and public-health authorities — that overprescribing antibiotics drives the emergence of antibiotic-resistant bacteria, and also to educational and stewardship efforts during the 1990s. ResearchGate+1

However, antibiotic overuse — and inappropriate prescribing — remain concerns: a 2014 review showed that, while prescribing declined from 2000 onward, overuse still persists and remains a leading driver of antibiotic resistance. SpringerLink+1

In the United States, the focus continues not only on reducing total antibiotic use, but on promoting guideline-concordant prescribing (i.e., prescribing antibiotics only when indicated, and using first-line appropriate agents). PMC+1

Key Updated References

Citation Full reference details
McCaig LF, Besser RE, Hughes JM. McCaig LF, Besser RE, Hughes JM. Trends in Antimicrobial Prescribing Rates for Children and Adolescents. JAMA. 2002 Jun 19;287(23):3096–3102. doi:10.1001/jama.287.23.3096. ResearchGate+1
Kozyrskyj AL, et al. Kozyrskyj AL, Mustard CA, Becker AB. Decrease in antibiotic use among children in the 1990s. Pediatrics. 2004 Sep;114(3):e214–e215. (Actually full article shows use decline from FY1995 to FY2001). PMC+1
Lee GC, et al. Lee GC, Reveles KL, Attridge RL, et al. Outpatient antibiotic prescribing in the United States: 2000 to 2010. BMC Medicine. 2014;12:96. doi:10.1186/1741-7015-12-96. SpringerLink
Poole NM, et al. Poole NM, Keren R, Localio AR, et al. Antibiotic Prescribing to Kids — Outpatient Emergency Department Visits, U.S. Pediatrics. 2019;144(6):e20190870. doi:10.1542/peds.2019-0870. PMC
CDC. Centers for Disease Control and Prevention. Office-Related Antibiotic Prescribing for Persons Aged ≤14 Years — United States, 1993–1994 to 2007–2008. MMWR. 2011 Sep 2;60(34):1153–1157. CDC

Note: The original text’s claim of “30 million prescriptions between 1999 and 2000 for children under 15” stems from the 2002 JAMA paper. The paper actually reports an average annual number for the 1999–2000 period of ~ 30.3 million, compared with ~ 45.5 million in 1989–1990. JAMA Network+1

Commentary & Caveats

  • The decline in antibiotic prescribing described in the 2002 JAMA study reflects physician-office (outpatient) prescribing only. It does not include prescriptions written during hospitalizations, telephone prescriptions, or prescriptions from non–office-based settings. ResearchGate+1

  • Later data (e.g., a 2011 report by the Centers for Disease Control and Prevention) show that while rates continued to fall among children ≤14 years — for example, office-visit–based prescribing dropped from 300 to 229 prescriptions per 1,000 visits between 1993–1994 and 2007–2008 — overall antibiotic prescribing remained “inappropriately high,” particularly for conditions often caused by viruses. CDC

  • Moreover, even though total prescribing decreased, inappropriate prescribing persists, especially in non–pediatric settings. A 2019 study found that children still receive millions of antibiotic prescriptions annually in emergency departments, many likely unnecessary. PMC

  • Efforts to reduce prescribing seemingly contributed to the decline (public-health campaigns, provider and parent education, antibiotic stewardship), but there remain structural and practice-based barriers (diagnostic uncertainty, parental expectations, time pressures) that maintain overuse risk. ResearchGate+2PMC+2