Statistical Brief #35 

Trends in Antibiotic Use among U.S. Children Aged 0 to 4 Years, 1996–2000 

By: William A. Carroll and G. Edward Miller 

Introduction 

In 1995, concerns about the overuse of antibiotics and the increasing prevalence of antibiotic 

resistant bacterial infections prompted the Centers for Disease Control and Prevention (CDC) to 

launch a national campaign to promote the appropriate use of antibiotics.1

 The majority of 

outpatient antibiotics in the United States are prescribed for respiratory tract infections, such as 

otitis media, bronchitis, and sinusitis, which are common ailments of young children. It is not 

surprising, therefore, that rates of antibiotic drug use are higher for young children than for any 

other age group2

 and that trends in antibiotic use among young children are a major public health 

concern. 

This Statistical Brief presents data from the Medical Expenditure Panel Survey–Household 

Component (MEPS-HC) on antibiotic drug use by children aged 0 to 4 years for the calendar 

years 1996 through 2000. The definition of antibiotics includes all major classes of oral 

antibiotics but excludes topical antibiotics.3

 All differences discussed in the text are statistically 

significant at the 0.05 level. 

Highlights 

• The proportion of children aged 0 to 4 years that used at least one antibiotic during the 

year decreased from 47.9 percent in 1996 to 38.1 percent in 2000. 

• The average number of antibiotic prescriptions decreased from 1.42 prescriptions per 

child in 1996 to 0.78 prescriptions per child in 2000. 

• The average expenditure for antibiotics decreased from $31.45 per child in 1996 (in 

Consumer Price Index-adjusted 2000 U.S. dollars) to $21.04 per child in 2000.4 

• Aggregate expenditures for antibiotics accounted for 53.8 percent of total drug spending 

by children in 1996 but accounted for 42.9 percent in 2000. 

1

 http://www.cdc.gov/drugresistance/community/ 

2

 Authors’ calculations using MEPS data. 

3

 Several subclasses of anti-infectives, including antifungals and antivirals, were also excluded. 4

 Expenditures are expressed in constant dollars by inflating all expenditures up to 2000 U.S. dollars using the 

Consumer Price Index for All Urban Consumers (CPI-U) for all items averaged across all U.S. cities. 
Findings 

In 1996, 47.9 percent of the approximately 19 million children aged 0 to 4 years had at least one 

prescription for an oral antibiotic during the year. By 2000, the proportion of young children 

using an antibiotic had fallen to 38.1 percent (figure 1). The downward trend in antibiotic use 

among children with an ambulatory care visit was similar to this trend for all children. In 1996, 

54.7 percent of children with an ambulatory care visit had at least one antibiotic. By 2000, the 

rate of use in this group had fallen to 44.8 percent. 

The average number of antibiotic prescriptions also declined from 1.42 prescriptions per child in 

1996 to 0.78 prescriptions per child in 2000 (figure 2). This decline resulted both because of a 

lower percentage of children with any antibiotic use and because children who used antibiotics 

had fewer prescriptions. Among children who used at least one antibiotic, the average number of 

prescriptions fell from 2.96 prescriptions per child in 1996 to 2.06 prescriptions per child by 

2000. 

Per capita expenditures for antibiotics among young children are shown in figure 3. Expenditures 

are expressed in constant dollars by inflating all expenditures up to 2000 U.S. dollars using the 

Consumer Price Index for All Urban Consumers (CPI-U) for all items averaged across all U.S. 

cities. In 1996, the average expenditure per child (in 2000 US dollars) was $31.45. By 2000, the 

average expenditure had fallen by 33 percent to $21.04 per child. Among children who used at 

least one antibiotic, the average expenditure fell from $65.69 per child in 1996 to $55.17 per 

child by 2000. 

Figure 4 shows aggregate expenditures for antibiotics as a percentage of all drug spending for 

children 0 to 4 years old. In 1996, expenditures for antibiotics accounted for 53.8 percent of all 

young children’s drug expenditures. By 2000, antibiotics accounted for 42.9 percent of all drug 

expenditures for young children in the United States. 

Data Source 

The estimates presented in this Statistical Brief come from the MEPS Full-Year Files 1996–2000 

(HC-012, HC-020, HC-028, HC-038, and HC-050) and MEPS Prescribed Medicines Files 

(PMED) 1996–2000 (HC-010A, HC-016A, HC-026A, HC-033A, and HC-051A). Each drug that 

was listed as purchased or otherwise obtained in the PMED files was assigned to a major 

therapeutic class and subclass by linking the PMED files to the Multum Lexicon database, a 

product of Cerner Multum, Inc. Antibiotics were identified with an algorithm that used Multum 

therapeutic classification variables. 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on 

health care utilization and expenditures, health insurance, and health status, as well as a wide 

variety of social, demographic, and economic characteristics for the civilian noninstitutionalized 

population. It is cosponsored by the Agency for Healthcare Research and Quality (AHRQ) and 

the National Center for Health Statistics (NCHS). 
For a detailed description of the MEPS-HC survey design, sample design, and methods used to 

minimize sources on nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. 

MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for 

Health Care Policy and Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. 

MEPS Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for 

Health Care Policy and Research, 1997. 

These publications and more information about MEPS are available on the MEPS Web site: 

http://www.meps.ahrq.gov/. 
Source: Center for Financing, Access,

one antibiotic prescription during the year, 1996 to 2000 

47.9 

40.0 38.1

41.4 

44.3 44.8 

50.5 

54.7 

47.7 

46.1 

35 

40 

45 

50 

55 

60 

1996 1997 1998 1999 2000 

All children Children with an ambulatory care visit 

Percent 

 and Cost Trends, AHRQ, Medical Expenditure 

Panel Survey–Household Component, 1996–2000 

Figure 1. Percentage of children 0 to 4 years old that had at least 
Source: Center for Financing, Access,

Figure 2. Average number of antibiotic prescriptions 

for children 0 to 4 years old, 1996 to 2000 

1.42 

1.05 0.88 0.88 0.78

2.37 2.06

2.96 

2.13 2.20 

0.0 

1.0 

2.0 

3.0 

4.0 

1996 1997 1998 1999 2000 

All children Children with at least one antibiotic prescription 

Number 

 and Cost Trends, AHRQ, Medical Expenditure 

Panel Survey–Household Component, 1996–2000 
Source: Center for Financing, Access,

Figure 3. Average expenditure for antibiotics, per child, 

children 0 to 4 years old, 1996 to 2000* 

31.45 

19.65 19.65 21.04

23.17 

52.29 55.17

65.69 

47.43 49.16 

10 

20 

30 

40 

50 

60 

70 

1996 1997 1998 1999 2000 

All children Children with at least one antibiotic prescription 

* Amounts have been adjusted for inflation to year 2000 dollars. 

Dollars 

 and Cost Trends, AHRQ, Medical Expenditure 

Panel Survey–Household Component, 1996–2000 
Source: Center for Financing, Access,

Figure 4. Antibiotic expenditures as a percentage of all 

drug expenditures for children 0 to 4 years old, 1996 to 2000 

53.8 

41.6 39.9 42.9

37.4 

10 

20 

30 

40 

50 

60 

70 

1996 1997 1998 1999 2000 

Percent 

 and Cost Trends, AHRQ, Medical Expenditure 

Panel Survey–Household Component, 1996–2000