OBJECTIVES: To describe temporal trends in vaccine uptake, rates of antibiotic prescriptions, and incidence of antibiotic-treated respiratory tract infections in children <5 years of age in the United States (US).

METHODS: We conducted an ecological study using the MarketScan administrative insurance claims database to explore relationships between pediatric vaccine uptake (pneumococcal conjugate, Haemophilus influenzae type b, diphtheria-tetanus-pertussis, and influenza) and antibiotic prescriptions and antibiotic-treated respiratory tract infections among US children <5 years of age.

RESULTS: This study reveals three concurrent trends in young children from 2000 through 2019: an increase in vaccine uptake, a decrease in antibiotic prescriptions, and a decline in antibiotic-treated respiratory tract infections. Vaccine uptake increased in 2004, following the recommendation for annual influenza vaccination, and it continued to increase in subsequent years. During 2004-2008, when all 4 of the study vaccines were recommended, rates of most antibiotic prescriptions and all respiratory tract infection episodes decreased. Notable decreases in antibiotic prescriptions and infection episodes during 2010-2013 coincided with the recommendation for use of PCV13 and the recommendation for universal influenza vaccination.

CONCLUSIONS: During 2000-2019, as uptake of vaccines increased, antibiotic prescriptions and antibiotic-treated respiratory tract infections declined. The trends observed in this ecologic study support the notion that vaccination programs may contribute to reduced antibiotic use in young children. These findings align with and strengthen similar conclusions drawn from prior controlled analyses conducted in smaller samples. While various factors besides vaccination may have influenced antibiotic use, future research using longitudinal patient-level data is warranted to further validate this association.