Antibiotics for a cold fell by half for children and not at all for adults

An acute viral upper respiratory tract infection is a cold. **An
antibiotic does nothing for it.** So the share of such visits where one is
given or prescribed is about as clean a measure of unnecessary prescribing as
routine data offers.

The two findings, in order

Children nearly halved — 17.9% to 10.1%. That is a large change in seven
years for a behaviour embedded in thousands of individual consultations.

Adults did not decline at all. And **in both periods the percentage for
adults was higher than for children.** The group that was prescribing more to
begin with is the group that did not change.

The overall drop from 23.4% to 17.6% is therefore almost entirely the
paediatric one. A single national figure moving in the right direction can
conceal a population where nothing happened, which is what stratifying by age
is for.

Why children moved and adults did not

The data does not say. What is worth noticing is that paediatric antibiotic
stewardship has been a named, specific campaign for years, with parental
expectation as its explicit target, while adult prescribing for respiratory
illness carries the ambiguity that keeps it going: an adult with a cough might
have bronchitis, might be older, might have something else. The clinical
uncertainty is greater, and so is the room for the prescription.

What is being counted

A visit with only one listed diagnosis from a set of codes that are
generally viral in origin — the common cold, acute laryngitis and
tracheitis, acute upper respiratory infections of multiple or unspecified
sites, and cough. Only one diagnosis, so a visit that also recorded
something bacterial is not in this count.

Antimicrobials are drugs categorised as anti-infectives in the Multum
Lexicon Plus therapeutic categories.

The sample is **emergency departments in non-institutional general and
short-stay hospitals** across the 50 states and DC, **excluding federal,
military and Veterans Administration hospitals** — the National Hospital
Ambulatory Medical Care Survey, 2010–2017.

*Source: Centers for Disease Control and Prevention, MMWR QuickStats;
National Center for Health Statistics.*