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Children often are prescribed antibiotics inappropriately in the outpatient setting. The harms of this practice are poorly characterized but could inform risk-benefit discussions with parents.
In a cohort of 2.8 million commercially insured U.S. children (median age, 8 years), investigators noted inappropriate prescribing (e.g., antibiotic therapy for viral infections or non–first-line antibiotic therapy for bacterial infections) in approximately one third of bacterial infection cases and as many as 70% (depending on the type of infection) of viral upper respiratory infection cases. For bacterial infections, inappropriate prescribing was associated with sixfold higher risk for Clostridioides difficile infections, fourfold higher risk for sev…