Systemic antibiotic prescribing to paediatric outpatients in 5 European countries: a population-based cohort study

Abstract

BackgroundTo describe the utilisation of antibiotics in children and adolescents across 5 European countries based on the same drug utilisation measures and age groups. Special attention was given to age-group-specific distributions of antibiotic subgroups, since comparison in this regard between countries is lacking so far.MethodsOutpatient paediatric prescriptions of systemic antibiotics during the years 2005-2008 were analysed using health care databases from the UK, the Netherlands, Denmark, Italy and Germany. Annual antibiotic prescription rates per 1,000 person years were estimated for each database and stratified by age (≤4, 5-9, 10-14, 15-18 years). Age-group-specific distributions of antibiotic subgroups were calculated for 2008.ResultsWith 957 prescriptions per 1000 person years, the highest annual prescription rate in the year 2008 was found in the Italian region Emilia Romagna followed by Germany (561), the UK (555), Denmark (481) and the Netherlands (294). Seasonal peaks during winter months were most pronounced in countries with high utilisation. Age-group-specific use varied substantially between countries with regard to total prescribing and distributions of antibiotic subgroups. However, prescription rates were highest among children in the age group ≤4 years in all countries, predominantly due to high use of broad spectrum penicillins.ConclusionsStrong increases of antibiotic prescriptions in winter months in high utilising countries most likely result from frequent antibiotic treatment of mostly viral infections. This and strong variations of overall and age-group-specific distributions of antibiotic subgroups across countries, suggests that antibiotics are inappropriately used to a large extent.

Bacteremia in children: epidemiology, clinical diagnosis and antibiotic treatment

“…Two examples of these such groups are the SACAR pediatric subgroup (UK specific) and ARPEC which looks at European data along with conducting point prevalence surveillance looking for intercontinental trends. Strict prescribing policies for antibiotics along with intensive efforts to promote guideline-appropriate prescribing habits to combat antibiotic resistance have been shown to be effective in the Netherlands [87]. Further preventative methods are discussed in the prevention section.…”

“…Data from SACAR also noted increases in amoxicillin prescribing since 2004 in the UK. Spain had the highest average rate of prescribing per 1000 persons whilst the UK and the Netherlands had the lowest rates [18,87].…”

Ambulantna poraba antibiotikov pri otrocih v Sloveniji

“…Število antibiotikov, ki so predpisani otrokom do 19-leta starosti, se giblje od manj kot 300 do več kot 1.500 receptov na 1000 otrok/leto (RTL) (Tabela 1) (1,5,6).…”

“…Za otroke nimamo definiranih DDD, zato smo povzeli vrednosti za odrasle. Porabo antibiotikov prikazujemo izraženo v DDD na 1000 prebivalcev na dan (DTD) in število receptov na 1000 otrok na leto Tabela 1: Stopnja predpisovanja antibiotikov (število receptov na 1000 otrok na leto) za ambulantno rabo v nekaterih evropskih državah (1,5,6 Ves čas raziskave je poraba antibiotikov upadala, z manjšimi porasti v različ-nih letih. Znižala se je poraba vseh antibiotičnih razredov, razen nitrofuranskih derivatov (nitrofurantoina), polimiksinov in kinolonov.…”

“…Pogosteje predpisujejo antibiotike zakasnelo. Zdravniki morajo več časa posvetiti razlagi, zakaj bolnik ne potrebuje antibiotika in neželenim učinkom vključno z razvojem odpornosti kot pa takoj predpisati antibiotik (2,4,6). Dosedanji ukrepi za izboljšanje predpisovanja antibiotikov v Sloveniji so bili opisani nedavno, vendar niso dovolj uspešni (13).…”