Community antibiotic prescribing for children in France from 2015 to 2017: a cross-sectional national study

Abstract

Objectives To assess recent community antibiotic prescribing for French children and identify areas of potential improvement. Methods We analysed 221 768 paediatric (<15 years) visits in a national sample of 680 French GPs and 70 community paediatricians (IQVIA’s EPPM database), from March 2015 to February 2017, excluding well-child visits. We calculated antibiotic prescription rates per 100 visits, separately for GPs and paediatricians. For respiratory tract infections (RTIs), we described broad-spectrum antibiotic use and duration of treatment. We used Poisson regression to identify factors associated with antibiotic prescribing. Results GPs prescribed more antibiotics than paediatricians [prescription rate 26.1 (95% CI 25.9–26.3) versus 21.6 (95% CI 21.0–22.2) per 100 visits, respectively; P < 0.0001]. RTIs accounted for more than 80% of antibiotic prescriptions, with presumed viral RTIs being responsible for 40.8% and 23.6% of all antibiotic prescriptions by GPs and paediatricians, respectively. For RTIs, antibiotic prescription rates per 100 visits were: otitis, 68.1 and 79.8; pharyngitis, 67.3 and 53.3; sinusitis, 67.9 and 77.3; pneumonia, 80.0 and 99.2; bronchitis, 65.2 and 47.3; common cold, 21.7 and 11.6; bronchiolitis 31.6 and 20.1; and other presumed viral RTIs, 24.1 and 11.0, for GPs and paediatricians, respectively. For RTIs, GPs prescribed more broad-spectrum antibiotics [49.8% (95% CI 49.3–50.3) versus 35.6% (95% CI 34.1–37.1), P < 0.0001] and antibiotic courses of similar duration (P = 0.21). After adjustment for diagnosis, antibiotic prescription rates were not associated with season and patient age, but were significantly higher among GPs aged ≥50 years. Conclusions Future antibiotic stewardship campaigns should target presumed viral RTIs, broad-spectrum antibiotic use and GPs aged ≥50 years.

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

“…The reduction is in line with observations made in children treated in the 2010s in paediatric emergency departments in France 13,14 . The use of broad‐spectrum antibiotics such as amoxicillin‐clavulanic acid decreased in the primary care clinics in USA, 7,12 and in the national antibiotic prescription data from France 15 . The use of broad‐spectrum antibiotics was not any notable problem in our data, although a marginal increase for amoxicillin‐clavulanic avid was seen in 2019–2020.…”

“…Our antibiotic prescription rate for bronchitis is in line with the international reports, 7,12,13 but our prescription rate for CAP was exceptionally low compared with the rates over 80% in other studies. [13][14][15] ments in France. 13,14 The use of broad-spectrum antibiotics such as amoxicillin-clavulanic acid decreased in the primary care clinics in USA, 7,12 and in the national antibiotic prescription data from France.…”

Outpatient Antibiotic Prescribing Patterns and Appropriateness for Children in Primary Healthcare Settings in Beijing City, China, 2017–2019

“…In this cross-sectional observational study, we identified the patterns of antibiotic use and evaluated the appropriateness of antibiotic prescriptions of PHIs in Beijing, China. We found that the pediatric antibiotic prescribing rate in PHIs in Beijing (15.1%) was lower than that in France (26.1%) [19], Australia (23%) [20], the Netherlands (29%) [21], Germany (38.6%) [22], and the United Kingdom (36.2%) [23], but was slightly higher than in Italy (8.81%) [24]. The GDP per capita of Beijing was 10,484 U.S. dollars, roughly equivalent to that of Malaysia (10,270 U.S. dollars) and Russia (10,037 U.S. dollars) [25].…”

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

“…However, French children were still 5.3-fold more likely than Dutch children to receive antibiotics. [68] Antibiotics are still mainly prescribed for viral infections [61] and strongly contribute to the increase in antibiotic resistance [ 26 , 61 ].…”