Trends in paediatric macrolide use in five European countries-a population-based study

Area of Science:

• Pharmacology and Pharmacoepidemiology
• Pediatric Infectious Diseases
• Antimicrobial Stewardship

Background:

• Macrolides are crucial antibiotics for pediatric infections.
• Understanding outpatient macrolide prescribing patterns is essential for antimicrobial stewardship.
• Variations in macrolide use across European countries require investigation.

Purpose of the Study:

• To analyze overall and subgroup-specific outpatient pediatric macrolide use in five European countries.
• To identify time trends in macrolide prescription rates.
• To inform interventions promoting judicious macrolide use.

Main Methods:

• Utilized healthcare databases from Denmark, Germany, Italy, the Netherlands, and the UK.
• Calculated macrolide prescription rates per 1000 person-years for pediatric outpatients (≤18 years).
• Employed Poisson regression analysis to assess time trends, adjusting for seasonality.

Main Results:

• Paediatric macrolide use in 2008 ranged from 47 to 199 prescriptions per 1000 person-years.
• Short-acting macrolide rates declined in most countries, while intermediate- and long-acting macrolide use increased in several.
• Significant seasonal variations in macrolide prescriptions were noted in Italy and Germany.

Conclusions:

• Increased use of intermediate- and long-acting macrolides may escalate antibiotic resistance due to prolonged half-life and broader activity.
• Marked seasonality in high-utilizing countries suggests macrolide overuse for viral respiratory infections.
• Findings highlight the need for targeted interventions to optimize pediatric macrolide prescribing.