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Using Prescription Patterns in Primary Care to Derive New Quality Indicators for Childhood Community Antibiotic

Sandra de Bie1, Florentia Kaguelidou, Katia M C Verhamme

  • 1From the *Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; †Department of Pediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, APHP; Univ Paris 7-Diderot, Sorbonne Paris Cité, EA08; INSERM CIC1426, Paris, France; ‡International Pharmaco-epidemiology and Pharmaco-economics Research Center, Desio, Italy; §Medicines Evaluations Board, Utrecht, The Netherlands; ¶Società Italiana di Medicina Generale, Florence, Italy; ‖Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; and **Paediatric Infectious Diseases Research Group, St George's University London, London, United Kingdom.

The Pediatric Infectious Disease Journal
|September 15, 2016
PubMed

Insights

Antibiotic prescribing in children varied significantly across European countries and age groups. New pediatric quality indicators reveal distinct prescribing patterns, aiding policy intervention monitoring.

Area of Science:

  • Pediatric pharmacology and public health.
  • Antimicrobial stewardship and drug utilization research.

Background:

  • Antibiotic resistance is a growing global concern, necessitating careful monitoring of antimicrobial use.
  • Understanding outpatient antibiotic prescribing patterns in children is crucial for effective stewardship.
  • Existing quality indicators may not fully capture pediatric-specific prescribing trends.

Purpose of the Study:

  • To characterize outpatient antibiotic prescribing patterns in children across three European nations.
  • To introduce and evaluate two novel pediatric-specific quality indicators (QIs) for antibiotic use.
  • To assess the utility of these QIs in monitoring prescribing trends and informing policy.

Main Methods:

  • A large-scale cohort study utilizing electronic primary care records from Italy, the UK, and the Netherlands (2001-2010).
  • Analysis included prevalence rates of antibiotic prescriptions, drug utilization (90% method), and development of pediatric-specific QIs (amoxicillin index, A/B ratio).
  • Calculation of the ratio of broad-spectrum to narrow-spectrum penicillin, cephalosporin, and macrolide users (B/N ratio).

Main Results:

  • Significant variations in annual antibiotic prescription prevalence were observed: 18.0% (Netherlands), 36.2% (UK), and 52.0% (Italy), with highest use in early childhood.
  • The amoxicillin index was highest in the Netherlands and UK (50-60%) but declined over time in the UK and Italy.
  • The A/B ratio in 2010 indicated substantial country-specific differences (0.3 in Italy, 1.7 in the Netherlands, 5.4 in the UK).

Conclusions:

  • Antibiotic prescribing patterns in children exhibit considerable variation based on age and country.
  • The developed pediatric-specific QIs, alongside prevalence data, offer a robust method for tracking community antibiotic prescribing trends in children.
  • These indicators can effectively monitor the impact of public health policies aimed at optimizing antibiotic use.
Abstract

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