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Updated: Sep 23, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Antibiotic prescribing for children. Too much and too little? Retrospective observational study in primary care

Suzie Ekins-Daukes1, James S McLay, Michael W Taylor

  • 1Department of Medicine and Clinical Pharmacology, The University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.

British Journal of Clinical Pharmacology
|July 10, 2003
PubMed

Insights

Off-label antibiotic prescribing in children, particularly lower doses, is common in primary care. This practice, often due to not adjusting doses for age, may increase antibiotic use and resistance risks.

Area of Science:

  • Pediatric pharmacology
  • Antimicrobial stewardship
  • Primary care medicine

Background:

  • Antibiotic prescribing in children is a significant public health concern.
  • Off-label prescribing, including incorrect dosing, is prevalent in pediatric primary care.
  • Understanding dose-related prescribing patterns is crucial for optimizing antibiotic use.

Purpose of the Study:

  • To investigate the prevalence of dose-related off-label antibiotic prescribing in children within primary care.
  • To identify clinical effects associated with off-label antibiotic dosing in pediatric patients.
  • To specifically examine the impact of lower-than-recommended antibiotic doses.

Main Methods:

  • Retrospective analysis of antibiotic prescriptions for 168,396 children (aged 0-16 years) in Scottish general practices (1999-2000).
  • Data extracted from the national Scottish primary care computer system (GPASS).
  • Comparison of prescribed doses against Summary of Product Characteristics (SPC) recommendations.

Main Results:

  • 14.2% of children received at least one antibiotic course; 19.2% were prescribed doses below SPC recommendations.
  • Lower-than-recommended doses were more frequent in older children (12-16 years) and at ages where SPCs recommend dose increases.
  • Prescribing sub-therapeutic doses was not linked to increased short-term re-prescription but was associated with a 48% rise in total annual antibiotic courses for 5-11 year olds.

Conclusions:

  • Off-label antibiotic prescribing at sub-therapeutic doses is common in pediatric primary care.
  • This prescribing pattern often results from failing to escalate antibiotic doses according to age-based SPC guidelines.
  • Standardizing age-based dosing increments could reduce off-label prescribing and mitigate antibiotic resistance development.
Abstract

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