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Published on: August 30, 2018
Systemic antibiotic prescribing to paediatric outpatients in 5 European countries: a population-based cohort study
Jakob Holstiege, Tania Schink, Mariam Molokhia
1Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstr, 30, 28359 Bremen, Germany. garbe@bips.uni-bremen.de.
Insights
Antibiotic use in European children and adolescents varies significantly by country, with highest rates in Italy and Germany. Inappropriate antibiotic prescribing, particularly for viral infections, is a concern across all studied nations.
Area of Science:
- Pediatric Pharmacology
- Public Health
- Infectious Disease Epidemiology
Background:
- Antibiotic utilization in pediatric populations across Europe lacks standardized comparative data.
- Understanding age-specific antibiotic subgroup distribution is crucial for comparative analysis.
Purpose of the Study:
- To describe and compare antibiotic utilization in children and adolescents across five European countries.
- To analyze age-group-specific distributions of antibiotic subgroups.
Main Methods:
- Analysis of outpatient pediatric systemic antibiotic prescriptions from 2005-2008 in the UK, Netherlands, Denmark, Italy, and Germany.
- Estimation of annual antibiotic prescription rates per 1,000 person-years, stratified by age groups (≤4, 5-9, 10-14, 15-18 years).
- Calculation of age-group-specific antibiotic subgroup distributions for 2008.
Main Results:
- In 2008, Italy (Emilia Romagna) had the highest prescription rate (957/1000 person-years), followed by Germany (561), UK (555), Denmark (481), and Netherlands (294).
- Seasonal peaks in antibiotic use were observed during winter months, most pronounced in high-utilization countries.
- Prescription rates were highest in children ≤4 years old across all countries, primarily due to broad-spectrum penicillin use. Significant inter-country variations in total prescribing and subgroup distributions were noted.
Conclusions:
- High winter antibiotic prescription rates in some countries likely stem from treating viral infections, indicating inappropriate use.
- Substantial variations in overall and age-specific antibiotic subgroup use across countries suggest widespread inappropriate antibiotic prescribing.
Background:
To 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.
Methods:
Outpatient 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.
Results:
With 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.
Conclusions:
Strong 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.
