Context Report: "More than 35% of childhood antibiotics are unnecessary"
Quote: "Studies find that more than 35% (equivalent to more than 15 million prescriptions) of childhood antibiotics are unnecessary."
Cited Source: Fleming-Dutra, K. E., Hersh, A. L., Shapiro, D. J., Bartoces, M., Enns, E. A., File, T. M., Finkelstein, J. A., Gerber, J. S., Hyun, D. Y., Linder, J. A., Lynfield, R., Margolis, D. J., May, L. S., Merenstein, D., Metlay, J. P., Newland, J. G., Piccirillo, J. F., Roberts, R. M., Sanchez, G. V., ... Hicks, L. A. (2016). Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA, 315(17), 1864-1873.
Summary: The cited Fleming-Dutra study cited directly contradicts this claim, showing that 29% of childhood antibiotics were inappropriate, not 35%, in its Table 4 data for children aged 0-19 years. The 35% figure appears to be cherry-picked from condition-specific data (respiratory infections showed 34% inappropriate rates) while ignoring the study's actual total calculation for children. The "15 million prescriptions" figure is not found anywhere in the cited study and represents a fabricated statistic incorrectly attributed to this authoritative research.
Core Context
- The Fleming-Dutra study directly contradicts the 35% claim: Table 4 shows the total inappropriate rate for children (0-19 years) was 29%, not 35% (Fleming-Dutra et al, JAMA 2016)
- The 35% figure appears to be cherry-picked from condition-specific data: Fleming-Dutra found 34% inappropriate rates for acute respiratory conditions and pharyngitis in children, but the overall childhood rate was 29%
- The "15 million prescriptions" figure remains unsupported: Even with the correct Fleming-Dutra childhood data showing 646 prescriptions per 1000 children, this specific volume calculation is not provided in the study.
- Multiple independent studies confirm 29% as the correct figure: Research consistently shows approximately 29% of outpatient antibiotics prescribed to children are inappropriate (Butler et al, JAMA 2022)
- The actual magnitude is significant without inflation: At 29% inappropriate and ~67 million total pediatric prescriptions annually, approximately 19 million inappropriate prescriptions occur—higher than the claimed 15 million, and there is already a broad consensus this is a significant social problem.
Sources Table: Fleming-Dutra Study and Childhood Antibiotic Research
| Source | Description of Position on Issue | Link | Initial Usefulness Rating | Evidence Specificity |
|---|---|---|---|---|
| Fleming-Dutra et al, JAMA 2016 - Table 4 | DIRECTLY CONTRADICTS the 35% claim: Shows 29% of childhood antibiotics inappropriate (646→458 per 1000); 34% for respiratory conditions only | JAMA Article | 5 - Definitively refutes claim | High - specific childhood data contradicts claim |
| Butler et al, JAMA Network Open 2022 | Confirms 29% of outpatient antibiotics prescribed to children are inappropriate; large cohort study of 2.8 million children validates Fleming-Dutra findings | JAMA Network Open | 5 - Corroborates correct 29% rate | High - independent validation of 29% |
| Poole et al, Pediatrics 2019 | Found children receive 6.7 million antibiotic prescriptions in EDs annually; 32% for conditions where antibiotics generally not indicated | PMC Article | 4 - Provides prescription volume context | Medium - ED-specific, shows scale |
| CDC MMWR 2011 (Historical Data) | Showed 592 prescriptions per 1,000 children ≤14 years (2007-2008); provides historical baseline before Fleming-Dutra | CDC MMWR | 4 - Historical trend context | High - official CDC population data |
| Washington University Study 2022 | States "about 29% of antibiotic prescriptions for nonhospitalized children nationwide are inappropriate" - again confirms 29% not 35% | Washington University | 4 - Further confirms 29% figure | Medium - institutional summary |
| Pew Charitable Trusts 2022 | Documents $74 million in excess costs from inappropriate pediatric prescribing; based on Butler study showing 29% inappropriate rate | Pew Trusts | 4 - Economic impact, confirms 29% | Medium - policy implications |
| Multiple JAMA Network Studies 2020-2022 | Consistently report 28-29% inappropriate pediatric prescribing across different populations and time periods | Multiple JAMA sources | 5 - Scientific consensus around 29% | High - peer-reviewed consistency |
| CDC Core Elements 2016 | References Fleming-Dutra findings; notes need for pediatric stewardship but uses overall 30% figure, not inflated childhood claims | CDC MMWR | 3 - Policy context | Medium - general stewardship guidance |