Antibiotic prescriptions for children younger than 5 years with acute upper respiratory infections in China: a retrospective nationwide claims database study

Abstract

Background In China, there were few studies to estimate antibiotic use for children with upper respiratory infections at the national level. The aim of this study was to describe the antibiotic prescribing practice for children aged < 5 years old with upper respiratory infections (URIs) using a nationwide claims database. Methods This was a retrospective cross-sectional study using a sampled database from the China Health Insurance Research Association (CHIRA). Study subjects included children younger than 5 years with outpatient visits in 2015 that resulted in a diagnosis of a upper respiratory infection. We calculated the percentage of visits who received antibiotics, the proportion of injection formulations, the percentage of combined antibiotics and the proportion of each antibiotic class. The patterns of antibiotic prescription were also described by medical institution type, city level and geographical region. Results Among the 92,821 visits, 27.1% were prescribed antibiotics, of which 27.0% received injection formulations. The rate of antibiotic prescribing varied by age group (P < 0.001), with the lowest (16.0%) in infants and the highest in patients at age 3 to < 4 years (29.9%) and age 4 to < 5 years (32.5%). The Midwestern region, underdeveloped cities and low-level hospitals represented relatively higher rates of prescribing antibiotics (P < 0.001) and higher proportions of injection dosage forms (P < 0.001). The most 3 common antibiotic classes prescribed of all visits with antibiotic prescriptions were the third-generation cephalosporins (34.9%), macrolides (24.3%), and the second-generation cephalosporins (23.3%). Conclusions In mainland China, the overall rate of antibacterial prescribing and the proportion of injection formulations prescribed in children under 5 years with URIs were at a low level, but still higher in underdeveloped regions and cities. Moreover, the overuse of the second and third generation cephalosporins, macrolides, remains a serious issue. Further efforts should be focused on reducing those non-first-line antibiotic prescribing and narrowing the gaps among regions and cities.

The Profile of Antibiotic Prescriptions in Pediatric Outpatients: A Retrospective Observational Study

“…In our study, the rate of antibiotic prescriptions was the highest (48.0%) in outpatients aged 3 to 6 and the lowest (6.0%) in adolescents. This distribution confirms the results of numerous previous studies, that showed the predominance of antibiotic use in preschool children [4][5]9,25].…”

“…This fact, at least in part, explains the predominance of penicillins in the United States and some European countries (the Netherlands, Denmark, Italy, and Spain) [1,5,[26][27]. In China, cephalosporins account for the majority of antibiotic prescriptions for this purpose [25,28].…”

Prevalence and Predictors of Antibiotic Prescriptions at Primary Healthcare Facilities in the Dodoma Region, Central Tanzania: A Retrospective, Cross-Sectional Study

“…Upper respiratory infection (URTI) was another empirically diagnosed condition in the current study, and antibiotic prescriptions among patients with URTI were almost double those with other disease conditions. This is comparatively higher than that in another study in Indonesia on the use of antibiotics in URTI, where 44% of the cases attended were prescribed antibiotics [ 35 ]; in another study involving antibiotic prescriptions for URTI in children under the age of five in China, 27.5% of all the 92,821 consultations of children between 3 to <5 years were prescribed antibiotics, accounting for over 60% of all the antibiotic prescriptions [ 36 ]. Additionally, in a study on antibiotic prescribing for URTI outpatients during influenza seasons involving 14,947 outpatients, over 40% were prescribed antibiotics, 41% of whom had conditions not requiring antibiotic therapy [ 37 ].…”

Antibiotics prescribing practices for sore throat in a sub-urban primary care clinic

“…12 Higher rates of antibiotic prescribing with an inappropriate selection of antibacterial doses are also observed in other parts of Asian subcontinent too. A nationwide retrospective cross-sectional study conducted in China by Xue et al 13 reporting the antibiotic prescribing practices in children aged less than 5 years with URTIs demonstrated that 27.1% were prescribed injectable antibiotics and that too at a higher dose. This trend was particularly noted in underprivileged areas.…”