Using Belgian pharmacy dispensing data to assess antibiotic use for children in ambulatory care

Abstract

Background The desired effect of antibiotics is compromised by the rapid escalation of antimicrobial resistance. Children are particularly at high-risk for unnecessary antibiotic prescribing, which is owing to clinicians’ diagnostic uncertainty combined with parents’ concerns and expectations. Recent Belgian data on ambulatory antibiotic prescribing practices for children are currently lacking. Therefore, we aim to analyse different aspects of antibiotic prescriptions for children in ambulatory care. Methods Pharmacy dispensing data on antibiotics for systematic use referring from 2010 to 2019 were retrieved from Farmanet, a database of pharmaceutical dispensations in community pharmacies. Population data were obtained from the Belgian statistical office (Statbel). Descriptive statistics were performed in Microsoft Excel. The Mann-Kendall test for trend analysis and the seasplot function for seasonality testing were conducted in R. Results The past decade, paediatric antibiotic use and expenditures have relatively decreased in Belgian ambulatory care with 35.5% and 44.3%, respectively. The highest volumes of antibiotics for children are prescribed by GPs working in Walloon region and rural areas, to younger children, and during winter. The most prescribed class of antibiotics for children are the penicillins and the biggest relative reduction in number of packages is seen for the sulfonamides and trimethoprim and quinolone antibacterials. Conclusions Paediatric antibiotic use has decreased in Belgian ambulatory care. Further initiatives are needed to promote prudent antibiotic prescribing in ambulatory care.

Incidence rates and trends of childhood urinary tract infections and antibiotic prescribing: registry-based study in general practices (2000 to 2020)

“…It remains uncertain why we found a low antibiotic prescribing rate and decrease in use of antibiotic therapy in children with UTI. The overall prescribing rate in children with UTI was comparable to other primary care studies (43-77%) [ 10 , 23 – 25 ], and a decrease in antibiotic use in children has also been described previously, based on pharmacy dispensing data in Belgium [ 21 ]. One possible explanation could be a high referral rate to secondary care, however in this study, data on other management actions than medication were not available.…”

“…There was an increase in use of laboratory urine tests in children < 10 years and a decrease in number of electronic antibiotic prescriptions in children > 2 years. This may indicate a change in clinical practice: GPs diagnosing UTI now more based on laboratory tests, a decrease in treatment of contaminated samples, an overall decrease in antibiotic use in children [ 21 ], an increase in use of compound (non-electronic) prescriptions (such as nitrofurantoin syrup), or GPs referring more children with UTI to secondary care instead of initiating antibiotics.…”

Antibiotiques Dans L Angine a Streptocoque a : Faut-Il Continuer ?

“…doivent faire exception et être traités d'emblée 17,19 . Les prescriptions d'antibiotiques en soins primaires chez les enfants ont diminué en Belgique entre 2010 et 2019 20 . L'augmentation des IISGA ne semble pas plus importante en Belgique qu'en France malgré la recommandation belge dont les auteurs ont confirmé leur position au début 2023 21 .…”

Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study

“…At the GP and paediatric outpatient setting prescribing rate in acute URTI were similar, respectively 19.1% and 20.1%, in the ED however it was 16.3%. In a recent study the pharmacy dispensing data on antibiotics in Belgium were analysed and it was found that GPs prescribed the most antibiotics [36]. Different reasons exist for inappropriate antibiotic prescribing, such as diagnostic uncertainty [8,9].…”