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Antibiotic management of children with infectious diseases in Dutch Primary Care
Anne R J Dekker1, Theo J M Verheij1, Alike W van der Velden1
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Antibiotics are frequently prescribed for childhood infections, often for respiratory issues. Dutch guidelines suggest reducing antibiotic use for upper respiratory tract infections and promoting narrow-spectrum options.
Area of Science:
- Pediatrics
- General Practice
- Infectious Diseases
- Pharmacology
Background:
- Childhood infections are prevalent in general practice settings.
- Clinical guidelines advocate for restricted antibiotic use in children, yet overprescribing remains a concern.
Purpose of the Study:
- To analyze antibiotic prescribing patterns for pediatric infections in relation to specific clinical diagnoses.
- To identify key areas for improving antibiotic management strategies in children.
Main Methods:
- An observational study utilizing consultation data from 45 Dutch general practices in 2012.
- Analysis of infectious disease episode incidence, prescription rates per 1000 person-years, and antibiotic subclass choices for common diagnoses across different age groups.
Main Results:
- An average of 262 antibiotic courses were prescribed per 1000 person-years, peaking in 1-year-olds.
- Antibiotics were used in 24% of infectious disease episodes, with acute otitis media being the most common indication.
- Amoxicillin was the most frequently prescribed antibiotic (55%), while narrow-spectrum antibiotics were infrequently used (10%).
Conclusions:
- Dutch improvement strategies should focus on reducing antibiotic prescriptions for acute upper respiratory tract infections and bronchitis.
- Promoting the use of narrow-spectrum antibiotics and decreasing the reliance on macrolides and amoxicillin/clavulanate are recommended.
- The findings provide valuable data for international comparisons of antibiotic policies in pediatric care.
Background:
Childhood infections are common in general practice. Although clinical guidelines recommend restrictive antibiotic use for children, antibiotics are too often prescribed.
Objective:
The aim of this study was to obtain insight in antibiotic prescribing for children related to clinical diagnoses. This is pivotal to define improvement strategies in the antibiotic management.
Methods:
In this observational study, we used consultation data collected from 45 general practices in the Netherlands in 2012. Infectious disease episode incidences, the number of antibiotic prescriptions per 1000 person-years, the proportion of episodes with an antibiotic prescription and the choice of antibiotic subclass were analysed for the most relevant diagnoses over different ages.
Results:
A total of 262 antibiotic courses were prescribed per 1000 person-years on average, with the highest number among children of 1 year (714/1000 person-years). Antibiotics were prescribed in 24% of infectious disease episodes. Acute upper respiratory tract infection (RTI) was the most common reason to visit the GP (173/1000 person-years), and the second most frequent indication to prescribe antibiotics. Antibiotics were most often prescribed for acute otitis media (58/1000 person-years). Amoxicillin dominated prescribing (55%), followed by macrolides (14%) and amoxicillin/clavulanate (10%), prescribing of narrow-spectrum antibiotics was low (10%).
Conclusion:
This detailed insight in antibiotic management of childhood infections shows targets for Dutch improvement strategies: (i) prevent antibiotic prescribing for acute upper RTI and bronchitis; (ii) stimulate the use of narrow-spectrum antibiotics; and (iii) reduce the use of macrolides and amoxicillin/clavulanate. Furthermore, this information is helpful to compare antibiotic policy between countries.
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