Requests for new oral antibiotic prescriptions in children within 2 days: a Norwegian population-based study

Abstract

Background. Children commonly refuse to take antibiotics, which may induce parents to request new antibiotic prescriptions with different pharmaceutical characteristics. Objectives. To investigate prescription changes for children 0-12 years receiving oral liquid or solid antibiotic formulations and to explore the relationships between prescription changes and characteristics related to the child, prescriber and antibiotic. Methods. A population-based registry study based on data from the Norwegian Prescription Database (NorPD) from 2004 to 2016. Antibiotic prescription changes were defined as the dispensing of subsequent antibiotics with different pharmaceutical characteristics to the same child within 2 days after initial prescriptions. Data were analysed using multivariable logistic regression and generalized estimating equations. Results. Requests for new prescriptions followed 3.0% of 2 691 483 initial antibiotic prescriptions for children. Young children who received solid formulations (10.9%) and certain poor-tasting antibiotics (8.6%) had the highest proportions of new prescriptions. Penicillin V was most commonly changed, while macrolides/lincosamides dominated subsequent prescriptions. In order of magnitude, the characteristics associated with requests for new prescriptions were the children's ages, poor taste and concentration of liquids, size and shape of solids, prescribers born in recent decades, and girl patients. Reimbursed prescriptions and scored solids were associated with fewer requests. Conclusions. While only 3% of the antibiotic prescriptions were changed, the preference of broadspectrum over narrow-spectrum antibiotics for young children in this study mirrors international prescription patterns. Avoiding the costs of children's refusal and consequent changes may thus be a motivation for choosing more preferred antibiotics.

Outcomes of antibiotic treatment for respiratory infections in children an observational study in primary care

“…Adverse events and bad taste resulted in several parents requesting prescription for another type of antibiotics. It has been previously shown that these new prescriptions are more often broad-spectrum antibiotics, which in turn may lead to increased antibiotic resistance [ 32 ]. Our results support that too many children are prescribed antibiotics; some parents even stated ending treatment early as their child was healthy or that the treatment was unnecessary.…”

Penicillin for enhver pris?

“…I en studie basert på Legemiddelregisteret fant man at ca. 5 % av penicillinreseptene ble erstattet med en annen forskrivning innen to dager etter forskrivningsdato (2). Dette blir rundt 2 000 resepter per år.…”

“…For små barn som ikke kan svelge tabletter, er vi ikke like sikre. Penicillin V-mikstur (heretter kalt penicillin) smaker bittert og er blant de mest upopulaere antibiotikamiksturene hos barn (2,3). Amoksicillin i mikstur har en smak som tolereres bedre, kan doseres sjeldnere samt har bedre biotilgjengelighet enn penicillin (2)(3)(4)(5)(6).…”

“…Penicillin V-mikstur (heretter kalt penicillin) smaker bittert og er blant de mest upopulaere antibiotikamiksturene hos barn (2,3). Amoksicillin i mikstur har en smak som tolereres bedre, kan doseres sjeldnere samt har bedre biotilgjengelighet enn penicillin (2)(3)(4)(5)(6). Bør vi vaere mer liberale med å bruke amoksicillinmikstur til små barn på bekostning av penicillinmikstur, selv om amoksicillin er noe mer bredspektret?…”

Antibacterial use by birth year and birth season in children 0-2 years in Norway

“…Possibly, we should also have investigated change in therapy 1-3 days after the first dispense. A recent Norwegian study found that 2-yearold children most frequently received a new prescription for liquid (2.7%) and solid antibacterials (10.7%) (34), suggesting that dispense rate may still be overestimated.…”