As vaccine coverage among young children rises, antibiotic use has plummeted, suggesting that immunizations may be quietly reshaping the battle against drug resistance. A recent study, titled “Temporal trends in vaccination and antibiotic use among young children in the United States, 2000–2019,” published in Antimicrobial Stewardship and Healthcare Epidemiology, examines this impact over two decades.
Antibiotic use is common and often medically inappropriate, promoting the emergence and rise of antimicrobial resistance (AMR). This poses an unprecedented public health challenge, threatening to take the world back to pre-antibiotic-era days. Intensive efforts have been made to promote proper antibiotic use during the study period, including clinical guidelines for managing infections and national action plans from the Centers for Disease Control and Prevention (CDC).
Study Overview and Findings
The study utilized the Merative® MarketScan Commercial Claims and Encounters database to collect data on the uptake of four common childhood vaccines and their impact on antibiotic prescriptions among children under five. The vaccines studied included pneumococcal conjugate, Haemophilus influenzae type b, diphtheria-tetanus-pertussis, and influenza vaccines.
According to the study, 32.5% of 6.7 million under-five children received all four vaccines in 2004. This increased to 67% in 2019, with only 2.5% remaining unvaccinated. Over the same period, antibiotic prescriptions fell by half, from 1.9 to 1.0 per person-year. The largest reductions in antibiotic use occurred during 2003-2007 and 2010-2013, with macrolide antibiotics seeing a 73% reduction.
Impact on Respiratory Infections
The study also highlighted a significant decrease in respiratory infections treated with antibiotics. Otitis media was the most common, while viral respiratory infections and throat infections also saw declines. During the study period, antibiotic-treated respiratory infections decreased by more than a third, from 2.4 to 1.6 episodes per person-year.
“The most significant drop in antibiotic use for viral infections occurred after integrating the flu vaccine into the routine childhood immunization schedule in 2004.”
Broader Implications and Analysis
The decline in antibiotic usage coincided with increased vaccine uptake until 2011. The introduction of the flu vaccine into routine childhood immunization schedules played a crucial role. After this point, the decline was primarily due to antibiotic stewardship programs, as vaccination rates remained stable until 2017.
Experts suggest that increased vaccine uptake and antibiotic stewardship efforts contributed jointly to this trend. Other factors include improved diagnostic testing, greater healthcare access for children, and rising socioeconomic status, which affects healthcare access and infection risk.
“These findings highlight the potential policy implications of integrating vaccination programs into antimicrobial stewardship efforts to help reduce unnecessary antibiotic use,” the study concludes.
Challenges and Future Directions
Despite the promising findings, the study authors caution that it cannot prove vaccination alone caused the reduction in antibiotic use. Future research should include Medicaid and uninsured children, who are less likely to be vaccinated, and explore the effects of different vaccine combinations.
Moreover, the increasing use of electronic health records may have helped track past medical history and antibiotic prescription practices, offering automated assistance in accessing best practices. The study suggests that immunization programs significantly affect public health beyond vaccine-preventable diseases.
Conclusion
The findings underscore the critical role of vaccines in reducing antibiotic use and combating drug resistance. As policymakers consider integrating vaccination programs into broader antimicrobial stewardship efforts, the study serves as a reminder of the multifaceted benefits of immunizations. The ongoing fight against antibiotic resistance will require a combination of increased vaccine uptake, effective stewardship programs, and continued research into the synergistic effects of vaccines.
