American Academy of Pediatrics

TABLE 3

Most Common Prescription Medication Combinations Used Among Children and Adolescents Concurrently Using Prescription Medications Overall and by Gender and Age Group in the United States (2009–2014)

	Prevalence of Combinations, No. (%) [95% CI]
	Overall, n = 993	0–5 y		6–12 y		13–19 y
	Overall, n = 993	Girls (n = 112)	Boys (n = 159)	Girls (n = 156)	Boys (n = 244)	Girls (n = 170)	Boys (n = 152)
Bronchodilators–respiratory inhalants	123 (10.5) [7.9–13.7]	12 (10.1) [5.1–19.3]^a	21 (21.4) [13.0–33.1]*	24 (13.8) [6.6–26.6]^a	38 (12.0) [8.1–17.4]	11 (3.5) [1.7–7.0]^a	17 (9.2) [5.1–15.9]**
Bronchodilators–leukotriene modifiers	99 (8.2) [6.3–10.4]	6 (4.6) [2.1–10.0]^a	12 (6.6) [3.0–13.8]^a	20 (8.9) [5.6–13.8]	36 (12.7) [8.4–18.6]	11 (6.6) [2.6–15.8]^a	14 (6.7) [3.5–12.6]^a
Bronchodilators–adrenal cortical steroids	96 (6.9) [5.1–9.2]	24 (15.8) [10.1–23.9]	29 (13.8) [8.0–22.7]	14 (10.4) [4.6–21.8]^a	18 (4.4) [2.7–7.2]**	6 (3.1) [1.1–8.3]^a	5 (5.1) [2.0–12.1]^a
CNS stimulants–α adrenergic blockers	54 (5.4) [3.7–7.7]	0 (0.0)	1 (0.4) [0.1–3.4]^a	8 (4.1) [1.8–9.2]^a	33 (13.8) [8.5–21.5]^***	0 (0.0)	12 (8.7) [4.5–16.1]^a ^***
Bronchodilators–nasal preparations	56 (5.3) [3.6–7.7]	1 (0.9) [0.1–6.5]^a	7 (4.6) [1.8–11.5]^a*	9 (3.5) [1.6–7.6]^a	25 (9.1) [5.4–14.9]*	5 (3.2) [0.7–13.0]^a	9 (6.7) [3.2–13.7]^a
Leukotriene modifiers–nasal preparations	47 (4.9) [3.2–7.3]	0 (0.0)	4 (2.4) [0.9–6.3]^a	11 (6.8) [3.1–14.3]^a	21 (8.9) [5.5–14.1]	2 (2.5) [0.4–14.0]^a	9 (5.2) [2.3–11.6]^a
Bronchodilators–antihistamines	50 (3.7) [2.6–5.1]	5 (4.2) [1.6–10.6]^a	4 (2.0) [0.7–6.0]^a	12 (6.1) [3.6–10.1]	18 (5.7) [3.2–9.9]	5 (2.3) [0.8–6.3]^a	6 (2.5) [1.2–5.0]^a
CNS stimulants–atypical antipsychotics	38 (3.5) [2.3–5.2]	0 (0.0)	0 (0.0)	5 (4.8) [2.1–10.4]^a	24 (8.2) [4.8–13.9]	2 (0.6) [0.1–2.5]^a	7 (4.5) [1.8–10.6]^a ^***
Nasal preparations–antihistamines	35 (3.4) [2.3–5.1]	0 (0.0)	0 (0.0)	6 (3.0) [1.5–5.7]^a	20 (8.2) [4.8–13.6]	2 (0.6) [0.1–2.8]^a	7 (5.3) [2.5–11.0]^a ^***
CNS stimulants–antidepressants	33 (3.4) [2.1–5.6]	0 (0.0)	0 (0.0)	7 (3.6) [1.4–8.5]^a	13 (5.4) [2.8–10.1]^a	6 (2.5) [0.7–8.3]^a	7 (5.6) [2.0–14.8]^a
Leukotriene modifiers–respiratory inhalants	42 (3.0) [2.1–4.4]	3 (2.1) [0.6–6.8]^a	5 (2.7) [1.1–6.5]^a	6 (2.4) [0.9–6.2]^a	19 (6.9) [3.8–12.5]**	4 (1.0) [0.3–2.8]^a	5 (2.3) [0.9–5.5]^a
Atypical antipsychotic–α adrenergic blockers	23 (2.6) [1.7–4.1]	0 (0.0)	0 (0.0)	2 (2.3) [0.5–10.8]^a	15 (7.2) [4.0–12.5]	1 (0.7) [0.1–4.7]^a	5 (2.9) [1.0–8.0]^a
CNS stimulants–antihistamines	24 (2.5) [1.3–4.6]^a	0 (0.0)	0 (0.0)	7 (4.2) [1.7–10.2]^a	13 (7.5) [3.5–15.4]^a	2 (0.4) [0.1–3.1]^a	2 (0.6) [0.1–2.9]^a
Bronchodilators–penicillins	38 (2.4) [1.6–3.5]	16 (12.0) [7.2–19.4]	12 (6.0) [3.2–10.9]^a*	5 (1.9) [0.7–5.6]^a	3 (0.7) [0.2–2.2]^a	1 (1.3) [0.2–9.1]^a	1 (0.4) [0.1–3.2]^a
Bronchodilators–CNS stimulants	26 (2.3) [1.4–3.9]	0 (0.0)	0 (0.0)	8 (4.2) [1.7–9.8]^a	12 (3.2) [1.9–5.4]	1 (1.9) [0.3–12.9]^a	5 (2.8) [0.8–8.9]^a
Antidepressants–anticonvulsants	11 (1.8) [0.8–4.4]^a	0 (0.0)	0 (0.0)	2 (3.0) [0.7–12.3]^a	2 (0.5) [0.1–2.1]^a*	5 (3.5) [0.8–14.0]^a	2 (2.1) [0.4–9.6]^a
Respiratory inhalants–adrenal cortical steroids	14 (1.7) [0.8–3.6]^a	2 (1.7) [0.4–7.1]^a	2 (1.7) [0.4–7.1]^a	4 (4.6) [1.0–18.7]^a	3 (0.9) [0.3–2.9]^a*	2 (0.9) [0.2–4.1]^a	1 (1.6) [0.2–11.0]^a
CNS stimulants–penicillins	22 (1.6) [0.9–3.0]	6 (4.9) [1.8–12.4]^a	5 (2.3) [0.9–5.8]^a	4 (1.9) [0.7–5.1]^a	3 (1.3) [0.4–4.0]^a	3 (1.7) [0.4–7.4]^a	1 (0.4) [0.0–2.9]^a
Narcotic analgesics–NSAIDs	13 (1.6) [0.7–3.6]^a	0 (0.0)	1 (0.2) [0.0–1.7]^a	2 (1.0) [0.2–4.4]^a	0 (0.0)	5 (2.4) [0.7–7.7]^a	5 (4.2) [1.3–13.1]^a
Contraceptives–antidepressants^b	6 (2.9) [1.2–7.0]^a	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	6 (5.3) [2.2–12.0]^a	0 (0.0)
Adrenal cortical steroids–leukotriene modifiers	22 (1.3) [0.8–2.2]	3 (1.9) [0.6–5.8]^a	7 (3.9) [1.5–9.6]^a	3 (1.1) [0.3–3.4]^a	5 (1.3) [0.4–3.5]^a	3 (0.9) [0.3–3.1]^a	1 (0.3) [0.0–2.5]^a
Bronchodilators–antidepressants	8 (1.3) [0.5–3.1]^a	0 (0.0)	0 (0.0)	0 (0.0)	3 (0.6) [0.2–2.1]^a	4 (4.0) [1.3–11.2]^a	1 (0.6) [0.1–4.7]^a*
Narcotic analgesics–penicillins	11 (1.2) [0.6–2.5]^a	0 (0.0)	0 (0.0)	1 (0.4) [0.0–2.6]^a	2 (0.7) [0.2–3.0]^a	6 (3.3) [1.2–8.8]^a	2 (0.8) [0.2–3.2]^a*
Adrenal cortical steroids–penicillins	12 (1.1) [0.5–2.3]^a	2 (1.0) [0.2–4.0]^a	5 (3.6) [1.4–9.4]^a	1 (0.3) [0.0–2.1]^a	2 (0.7) [0.2–2.8]^a	2 (1.6) [0.3–8.3]^a	0 (0.0)
Bronchodilators–NSAIDs	13 (1.1) [0.6–1.9]	1 (1.4) [0.2–9.3]^a	5 (3.0) [0.9–9.5]^a	1 (0.6) [0.1–4.8]^a	0 (0.0)	3 (1.3) [0.4–4.7]^a	3 (1.0) [0.3–3.3]^a
Penicillins–macrolides	5 (1.0) [0.2–4.2]^a	2 (6.0) [0.9–30.5]^a	1 (2.7) [0.4–16.7]^a ^***	1 (1.1) [0.1–8.3]^a	0 (0.0)	1 (0.5) [0.1–3.2]^a	0 (0.0)
Antidepressants–PPIs	5 (1.0) [0.3–3.1]^a	0 (0.0)	0 (0.0)	1 (0.7) [0.1–5.0]^a	1 (0.2) [0.0–1.5]^a	3 (3.3) [0.9–11.4]^a	0 (0.0)
Contraceptives–dermatological agents^b	3 (2.1) [0.6–7.0]^a	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	3 (3.7) [1.1–12.0]^a	0 (0.0)
Penicillins–nasal preparations	6 (0.8) [0.3–2.4]^a	1 (5.6) [0.7–31.8]^a	0 (0.0)	3 (2.0) [0.4–8.5]^a	2 (0.8) [0.2–3.2]^a	0 (0.0)	0 (0.0)
Macrolides–nasal preparations	5 (0.6) [0.2–2.3]^a	1 (5.6) [0.7–31.8]^a	1 (0.3) [0.0–2.4]^a**	0 (0.0)	2 (0.5) [0.1–2.0]^a	1 (0.4) [0.0–2.8]^a	0 (0.0)
Bronchodilators–cephalosporins	6 (0.6) [0.2–1.5]^a	1 (1.0) [0.1–7.6]^a	4 (3.9) [1.2–11.8]^a	0 (0.0)	1 (0.2) [0.0–1.6]^a	0 (0.0)	0 (0.0)
Penicillins–cephalosporins	4 (0.5) [0.2–1.5]^a	2 (3.6) [0.6–18.5]^a	2 (2.1) [0.5–8.0]^a	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)

	Prevalence of Combinations, No. (%) [95% CI]
	Overall, n = 993	0–5 y		6–12 y		13–19 y
	Overall, n = 993	Girls (n = 112)	Boys (n = 159)	Girls (n = 156)	Boys (n = 244)	Girls (n = 170)	Boys (n = 152)
Bronchodilators–respiratory inhalants	123 (10.5) [7.9–13.7]	12 (10.1) [5.1–19.3]^a	21 (21.4) [13.0–33.1]*	24 (13.8) [6.6–26.6]^a	38 (12.0) [8.1–17.4]	11 (3.5) [1.7–7.0]^a	17 (9.2) [5.1–15.9]**
Bronchodilators–leukotriene modifiers	99 (8.2) [6.3–10.4]	6 (4.6) [2.1–10.0]^a	12 (6.6) [3.0–13.8]^a	20 (8.9) [5.6–13.8]	36 (12.7) [8.4–18.6]	11 (6.6) [2.6–15.8]^a	14 (6.7) [3.5–12.6]^a
Bronchodilators–adrenal cortical steroids	96 (6.9) [5.1–9.2]	24 (15.8) [10.1–23.9]	29 (13.8) [8.0–22.7]	14 (10.4) [4.6–21.8]^a	18 (4.4) [2.7–7.2]**	6 (3.1) [1.1–8.3]^a	5 (5.1) [2.0–12.1]^a
CNS stimulants–α adrenergic blockers	54 (5.4) [3.7–7.7]	0 (0.0)	1 (0.4) [0.1–3.4]^a	8 (4.1) [1.8–9.2]^a	33 (13.8) [8.5–21.5]^***	0 (0.0)	12 (8.7) [4.5–16.1]^a ^***
Bronchodilators–nasal preparations	56 (5.3) [3.6–7.7]	1 (0.9) [0.1–6.5]^a	7 (4.6) [1.8–11.5]^a*	9 (3.5) [1.6–7.6]^a	25 (9.1) [5.4–14.9]*	5 (3.2) [0.7–13.0]^a	9 (6.7) [3.2–13.7]^a
Leukotriene modifiers–nasal preparations	47 (4.9) [3.2–7.3]	0 (0.0)	4 (2.4) [0.9–6.3]^a	11 (6.8) [3.1–14.3]^a	21 (8.9) [5.5–14.1]	2 (2.5) [0.4–14.0]^a	9 (5.2) [2.3–11.6]^a
Bronchodilators–antihistamines	50 (3.7) [2.6–5.1]	5 (4.2) [1.6–10.6]^a	4 (2.0) [0.7–6.0]^a	12 (6.1) [3.6–10.1]	18 (5.7) [3.2–9.9]	5 (2.3) [0.8–6.3]^a	6 (2.5) [1.2–5.0]^a
CNS stimulants–atypical antipsychotics	38 (3.5) [2.3–5.2]	0 (0.0)	0 (0.0)	5 (4.8) [2.1–10.4]^a	24 (8.2) [4.8–13.9]	2 (0.6) [0.1–2.5]^a	7 (4.5) [1.8–10.6]^a ^***
Nasal preparations–antihistamines	35 (3.4) [2.3–5.1]	0 (0.0)	0 (0.0)	6 (3.0) [1.5–5.7]^a	20 (8.2) [4.8–13.6]	2 (0.6) [0.1–2.8]^a	7 (5.3) [2.5–11.0]^a ^***
CNS stimulants–antidepressants	33 (3.4) [2.1–5.6]	0 (0.0)	0 (0.0)	7 (3.6) [1.4–8.5]^a	13 (5.4) [2.8–10.1]^a	6 (2.5) [0.7–8.3]^a	7 (5.6) [2.0–14.8]^a
Leukotriene modifiers–respiratory inhalants	42 (3.0) [2.1–4.4]	3 (2.1) [0.6–6.8]^a	5 (2.7) [1.1–6.5]^a	6 (2.4) [0.9–6.2]^a	19 (6.9) [3.8–12.5]**	4 (1.0) [0.3–2.8]^a	5 (2.3) [0.9–5.5]^a
Atypical antipsychotic–α adrenergic blockers	23 (2.6) [1.7–4.1]	0 (0.0)	0 (0.0)	2 (2.3) [0.5–10.8]^a	15 (7.2) [4.0–12.5]	1 (0.7) [0.1–4.7]^a	5 (2.9) [1.0–8.0]^a
CNS stimulants–antihistamines	24 (2.5) [1.3–4.6]^a	0 (0.0)	0 (0.0)	7 (4.2) [1.7–10.2]^a	13 (7.5) [3.5–15.4]^a	2 (0.4) [0.1–3.1]^a	2 (0.6) [0.1–2.9]^a
Bronchodilators–penicillins	38 (2.4) [1.6–3.5]	16 (12.0) [7.2–19.4]	12 (6.0) [3.2–10.9]^a*	5 (1.9) [0.7–5.6]^a	3 (0.7) [0.2–2.2]^a	1 (1.3) [0.2–9.1]^a	1 (0.4) [0.1–3.2]^a
Bronchodilators–CNS stimulants	26 (2.3) [1.4–3.9]	0 (0.0)	0 (0.0)	8 (4.2) [1.7–9.8]^a	12 (3.2) [1.9–5.4]	1 (1.9) [0.3–12.9]^a	5 (2.8) [0.8–8.9]^a
Antidepressants–anticonvulsants	11 (1.8) [0.8–4.4]^a	0 (0.0)	0 (0.0)	2 (3.0) [0.7–12.3]^a	2 (0.5) [0.1–2.1]^a*	5 (3.5) [0.8–14.0]^a	2 (2.1) [0.4–9.6]^a
Respiratory inhalants–adrenal cortical steroids	14 (1.7) [0.8–3.6]^a	2 (1.7) [0.4–7.1]^a	2 (1.7) [0.4–7.1]^a	4 (4.6) [1.0–18.7]^a	3 (0.9) [0.3–2.9]^a*	2 (0.9) [0.2–4.1]^a	1 (1.6) [0.2–11.0]^a
CNS stimulants–penicillins	22 (1.6) [0.9–3.0]	6 (4.9) [1.8–12.4]^a	5 (2.3) [0.9–5.8]^a	4 (1.9) [0.7–5.1]^a	3 (1.3) [0.4–4.0]^a	3 (1.7) [0.4–7.4]^a	1 (0.4) [0.0–2.9]^a
Narcotic analgesics–NSAIDs	13 (1.6) [0.7–3.6]^a	0 (0.0)	1 (0.2) [0.0–1.7]^a	2 (1.0) [0.2–4.4]^a	0 (0.0)	5 (2.4) [0.7–7.7]^a	5 (4.2) [1.3–13.1]^a
Contraceptives–antidepressants^b	6 (2.9) [1.2–7.0]^a	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	6 (5.3) [2.2–12.0]^a	0 (0.0)
Adrenal cortical steroids–leukotriene modifiers	22 (1.3) [0.8–2.2]	3 (1.9) [0.6–5.8]^a	7 (3.9) [1.5–9.6]^a	3 (1.1) [0.3–3.4]^a	5 (1.3) [0.4–3.5]^a	3 (0.9) [0.3–3.1]^a	1 (0.3) [0.0–2.5]^a
Bronchodilators–antidepressants	8 (1.3) [0.5–3.1]^a	0 (0.0)	0 (0.0)	0 (0.0)	3 (0.6) [0.2–2.1]^a	4 (4.0) [1.3–11.2]^a	1 (0.6) [0.1–4.7]^a*
Narcotic analgesics–penicillins	11 (1.2) [0.6–2.5]^a	0 (0.0)	0 (0.0)	1 (0.4) [0.0–2.6]^a	2 (0.7) [0.2–3.0]^a	6 (3.3) [1.2–8.8]^a	2 (0.8) [0.2–3.2]^a*
Adrenal cortical steroids–penicillins	12 (1.1) [0.5–2.3]^a	2 (1.0) [0.2–4.0]^a	5 (3.6) [1.4–9.4]^a	1 (0.3) [0.0–2.1]^a	2 (0.7) [0.2–2.8]^a	2 (1.6) [0.3–8.3]^a	0 (0.0)
Bronchodilators–NSAIDs	13 (1.1) [0.6–1.9]	1 (1.4) [0.2–9.3]^a	5 (3.0) [0.9–9.5]^a	1 (0.6) [0.1–4.8]^a	0 (0.0)	3 (1.3) [0.4–4.7]^a	3 (1.0) [0.3–3.3]^a
Penicillins–macrolides	5 (1.0) [0.2–4.2]^a	2 (6.0) [0.9–30.5]^a	1 (2.7) [0.4–16.7]^a ^***	1 (1.1) [0.1–8.3]^a	0 (0.0)	1 (0.5) [0.1–3.2]^a	0 (0.0)
Antidepressants–PPIs	5 (1.0) [0.3–3.1]^a	0 (0.0)	0 (0.0)	1 (0.7) [0.1–5.0]^a	1 (0.2) [0.0–1.5]^a	3 (3.3) [0.9–11.4]^a	0 (0.0)
Contraceptives–dermatological agents^b	3 (2.1) [0.6–7.0]^a	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	3 (3.7) [1.1–12.0]^a	0 (0.0)
Penicillins–nasal preparations	6 (0.8) [0.3–2.4]^a	1 (5.6) [0.7–31.8]^a	0 (0.0)	3 (2.0) [0.4–8.5]^a	2 (0.8) [0.2–3.2]^a	0 (0.0)	0 (0.0)
Macrolides–nasal preparations	5 (0.6) [0.2–2.3]^a	1 (5.6) [0.7–31.8]^a	1 (0.3) [0.0–2.4]^a**	0 (0.0)	2 (0.5) [0.1–2.0]^a	1 (0.4) [0.0–2.8]^a	0 (0.0)
Bronchodilators–cephalosporins	6 (0.6) [0.2–1.5]^a	1 (1.0) [0.1–7.6]^a	4 (3.9) [1.2–11.8]^a	0 (0.0)	1 (0.2) [0.0–1.6]^a	0 (0.0)	0 (0.0)
Penicillins–cephalosporins	4 (0.5) [0.2–1.5]^a	2 (3.6) [0.6–18.5]^a	2 (2.1) [0.5–8.0]^a	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)

Estimates are restricted to children who report the use of ≥2 prescription medications.

Estimates are unreliable; relative SE >30%.

Estimates are restricted to girls.

***

P < .01; ** P < .05; * P < .10 by using χ² tests to determine differences between girls and boys.

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