Antibiotic prescriptions for children with lower respiratory tract infections fell from 2014 to 2020, but misuse was still an issue

Abstract

Aim We evaluated main trends in antibiotic prescriptions for children with lower respiratory tract infection (LRTI) by Terveystalo, Finland's largest private healthcare company. Methods The study comprised of 89,359 children aged 0–17 years (57.2% boys) who visited Terveystalo primary care clinics from 2014 to 2020 with LRTI. The data were assessed by age, study year, location, the doctor's speciality and whether the diagnosis was bronchitis or community‐acquired pneumonia (CAP). Results There were gradual decreases in overall antibiotic prescription rates during the study period (37.0% in 2014 vs. 20.1% in 2020) and in prescribed macrolides (16.8% vs. 7.5%). Altogether, 31.3% of 72,737 children with bronchitis and 22.5% of those 16,622 with CAP‐received antibiotics. Macrolides were the most frequently prescribed antibiotics for bronchitis, at more than 40%, without any substantial relative decrease during the study. Costs of antibiotics increased from 2014 to 2016 and then decreased in line with the reduction in prescriptions. However, there was still a marked overuse of antibiotics, especially macrolides, for children with bronchitis. The relative use of amoxicillin for CAP increased from 41.4% to 65.4% between 2016 and 2020, in line with current guidelines. Conclusion Despite an overall reduction in prescribed antibiotics, some antibiotics were still overused, particularly macrolides for bronchitis.

Outpatient Antibiotic Prescribing for 357,390 Children With Otitis Media

“…The Finnish Current Care guidelines recommend antibiotics for children with pneumonia, 4 and in the same study population from which the present cases were selected, uncomplicated acute bronchitis was treated with antibiotics in 30% of the cases. 5 The rationale beyond the exclusion was that a lower respiratory tract infection, if present, would influence the start and selection of antibiotics. Overall, 357,390 OM cases (55.2% boys) were included in the present study.…”

Restrictions for COVID‐19 prevented other respiratory infections and reduced emergency visits in children

“…In 2019, over 12 000 children visited for lower respiratory tract infection (LRTI) the primary care clinics of the largest private healthcare company of the country, and in 2020, the number of visits was about 5000 2 . The decrease was 61% for bronchitis and 49% for community‐acquired pneumonia.…”

“…Prescriptions of antibiotics decreased by more than 20% for children younger than 5 and older than 10 years of age. and this reduction came mainly from less prescribing of macrolides for children with bronchitis 2 . Instead, the proportion of amoxicillin used for community‐acquired pneumonia increased 2 .…”

“…and this reduction came mainly from less prescribing of macrolides for children with bronchitis. 2 Instead, the proportion of amoxicillin used for community‐acquired pneumonia increased. 2 Overall, the costs for antibiotics decreased in line with less prescriptions.…”

“… 2 Instead, the proportion of amoxicillin used for community‐acquired pneumonia increased. 2 Overall, the costs for antibiotics decreased in line with less prescriptions. These observations suggest that children who visited primary care presented with more severe respiratory infections during the pandemic than before it.…”