Association between National Treatment Guidelines for Upper Respiratory Tract Infections and Outpatient Pediatric Antibiotic Use in France: An Interrupted Time–Series Analysis

Trinh, Nhung T H; Bruckner, Tim A.; Lemaître, Magali; Chauvin, Françoise; Lévy, Corinne; Chahwakilian, Pierre; Cohen, Robert; Chalumeau, Martin; Cohen, Jérémie F.

doi:10.1016/j.jpeds.2019.09.017

Cited by 24 publications

(41 citation statements)

References 37 publications

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“…Indeed, Trinh et al. [26] highlighted a significant impact of French guidelines promoting a better use of antibiotics for upper respiratory tract infections, which led to a decrease by 33% in antibiotics prescription rates per 1000 paediatric inhabitants/year. Our results allowed to show that although slightly fewer children received antibiotics prescriptions per year (decrease by 12%; Table 2 ), these prescriptions were especially less often repeated in the same year (decrease by 23%; Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Since this publication , several regulations came into force in France and included the cessation of the reimbursement of nasal decongestants [23] , the removal of cough drugs from the market for the youngest children [24] , warnings related to the safety of NSAIDs [25] , and recommendations promoting the better use of antibiotics for upper respiratory tract infection [26] , with the latter leading to significant change in prescription patterns . In this context, POPs may have significantly changed.…”

Section: Introductionmentioning

confidence: 99%

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Paediatric outpatient prescriptions in France between 2010 and 2019: A nationwide population-based study

Taine

Offredo

Dray‐Spira³

et al. 2021

The Lancet Regional Health - Europe

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Background Paediatric outpatient prescription (POP) monitoring is pivotal to identify inadequate prescriptions and optimize drug use. We aimed at describing recent trends in POPs in France. Methods All reimbursed dispensations of outpatient prescribed drugs (excluding vaccines) were prospectively collected for the paediatric population (<18 years old) in the French national health database in 2010–2011 and 2018–2019 (mean 117,356,938/year). POP prevalence (proportion of children receiving ≥1 drug prescriptions/year) was calculated by age groups and compared by prevalence rate ratios (PRRs). Given the large sample size, 95% confidence intervals of POP prevalences and PRRs did not differ from estimates. Findings Among the 14,510,023 children resident in France in 2018–2019, mean POP prevalence was 857‰ children. Most prescribed therapeutic classes were analgesics (643‰), antibiotics (405‰), nasal corticosteroids (328‰), nonsteroidal anti-inflammatory drugs (NSAIDs) (244‰), antihistamines (246‰) and systemic corticosteroids (210‰). POPs decreased with age from 976‰ for infants to 782‰ for adolescents. Children <6 years old were notably more exposed to inhaled corticosteroids (PRR=3.06), non-penicillin beta-lactam antibacterial agents (PRR=3.05) and systemic corticosteroids (PRR=2.11) than older ones. The POP prevalence was slightly higher (PRR=1.04) during 2018–2019 than 2010–2011, with marked increases for anti-emetics (PRR=1.84), vitamin D (PRR=1.49), proton pump inhibitors (PRR=1.42), systemic contraceptives (PRR=1.24) and nasal corticosteroids (PRR=1.21) and decreases for propulsive/prokinetic agents (PRR=0.09), NSAIDs (PRR=0.73) and systemic antibiotics (PRR=0.88). Interpretation POP remained highly prevalent in France throughout the 2010s, especially for children <6 years old, with only a few improvements for selected therapeutic classes. These findings should prompt clinical guidance campaigns and/or regulatory policies. Funding Internal funding

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Paediatric outpatient prescriptions in France between 2010 and 2019: A nationwide population-based study

Taine

Offredo

Dray‐Spira³

et al. 2021

The Lancet Regional Health - Europe

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“…Antibiotics are one of the most common medications prescribed for outpatients [1][2][3], and Upper Respiratory Infections (URIs) account for approximately 50-70% of total antibiotic prescriptions, even though most cases are of viral origin [4][5][6][7]. A prior study in US estimating potential rate of inappropriate outpatient antibiotic use had relied on estimates of bacterial prevalence and concluded that more than 50% of antibiotics for URIs were unnecessary [8].…”

Section: Introductionmentioning

confidence: 99%

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

Xue

Shen

et al. 2021

BMC Infect Dis

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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.

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“…Bacterial URTI requires antibiotic treatment. However, the overuse of antibiotics in children with acute upper respiratory tract infection is serious ( Cheng et al, 2019 ; Kuchar et al, 2015 ; Trinh et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Serum β2-microglobulin may be a viral biomarker by analyzing children with upper respiratory tract infections and exanthem subitum: a retrospective study

Cai

Zhou

et al. 2021

PeerJ

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Background Due to the lack of effective and feasible viral biomarkers to distinguish viral infection from bacterial infection, children often receive unnecessary antibiotic treatment. To identify serum β2-microglobulin that distinguishes bacterial upper respiratory tract infection from viral upper respiratory tract infection and exanthem subitum in children. Methods This retrospective study was conducted from January 1, 2019 to September 30, 2020 in Yancheng Third People’s Hospital. Children with upper respiratory tract infection and exanthem subitum were recruited. The concentration of serum β2-microglobulin in the viral and bacterial infection groups were statistically analyzed. Results A total of 291 children included 36 with bacterial upper respiratory tract infection (median age, 13 months; 44.4% female), 197 with viral upper respiratory tract infection (median age, 12 months; 43.7% female) and 58 with exanthem subitum (median age, 13 months; 37.9% female). When the concentration of β2-microglobulin was 2.4mg/L, the sensitivity to distinguish viral from bacterial upper respiratory tract infection was 81.2% (95% CI [75.1–86.4%]), and the specificity was 80.6% (95% CI [64.0–91.8]%). When the cutoff was 2.91 mg/L, the sensitivity of β2-microglobulin to distinguish exanthem subitum from bacterial upper respiratory tract infection was 94.8% (95% CI [85.6–98.9]%), and the specificity was 100% (95% CI [90.3–100]%). Conclusions Serum β2-microglobulin may be a significant biological indicator in children with upper respiratory tract infection and exanthem subitum.

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Association between National Treatment Guidelines for Upper Respiratory Tract Infections and Outpatient Pediatric Antibiotic Use in France: An Interrupted Time–Series Analysis

Cited by 24 publications

References 37 publications

Paediatric outpatient prescriptions in France between 2010 and 2019: A nationwide population-based study

Paediatric outpatient prescriptions in France between 2010 and 2019: A nationwide population-based study

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

Serum β2-microglobulin may be a viral biomarker by analyzing children with upper respiratory tract infections and exanthem subitum: a retrospective study

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