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Factors predicting amoxicillin prescribing in primary care among children: a cohort study
Faith Miller1, Ania Zylbersztejn2, Graziella Favarato2
1Institute for Global Health, University College London, London.
Insights
Antibiotic prescribing for childhood respiratory infections is linked to socioeconomic status and ethnic background. Reducing respiratory infection spread in homes and childcare can lower antibiotic use in primary care.
Area of Science:
- Pediatric Health
- Public Health
- Antimicrobial Stewardship
Background:
- Childhood antibiotic prescribing, primarily for respiratory tract infections (RTIs), significantly contributes to antimicrobial resistance, a critical global health issue.
- Understanding factors influencing antibiotic use in young children is essential for developing targeted interventions to combat resistance.
Purpose of the Study:
- To investigate factors associated with amoxicillin prescribing in young children.
- To identify determinants of respiratory tract infection (RTI) consultation attendance in primary care settings.
Main Methods:
- A prospective cohort study was conducted in Bradford, UK, from pregnancy to 24 months of age (2007-2013).
- Data from electronic primary care records and air pollution data were linked.
- Mixed-effects logistic regression models were used to analyze amoxicillin prescribing and RTI consultation rates, with general practice (GP) surgery as a random effect.
Main Results:
- Amoxicillin prescribing rates were high, with 710/1000 child-years in year 1 and 780/1000 child-years in year 2.
- Factors associated with increased amoxicillin prescribing included male sex, socioeconomic deprivation, Pakistani ethnic background, and preterm birth (<39 weeks gestation).
- Additional risk factors identified were caesarean delivery, congenital anomalies, household overcrowding, birth season, and childcare attendance, with GP surgery accounting for 7%-9% of prescribing variation.
Conclusions:
- Socioeconomic status and ethnic background are significant predictors of amoxicillin prescribing in young children.
- Interventions aimed at reducing respiratory infection transmission in household and childcare environments may effectively decrease antibiotic prescribing in primary care.
Background:
Antibiotic prescribing during childhood, most commonly for respiratory tract infections (RTIs), contributes to antimicrobial resistance, which is a major public health concern.
Aim:
To identify factors associated with amoxicillin prescribing and RTI consultation attendance in young children in primary care.
Design And Setting:
Cohort study in Bradford spanning pregnancy to age 24 months, collected 2007-2013, linked to electronic primary care and air pollution data.
Method:
Amoxicillin prescribing and RTI consultation rates/1000 child-years were calculated. Mixed-effects logistic regression models were fitted with general practice (GP) surgery as the random effect.
Results:
The amoxicillin prescribing rate among 2493 children was 710/1000 child-years during year 1 (95% confidence interval [CI] = 677 to 744) and 780/1000 (95% CI = 745 to 816) during year 2. During year 1, odds of amoxicillin prescribing were higher for boys (adjusted odds ratio [aOR] 1.36, 95% CI = 1.14 to 1.61), infants from socioeconomically deprived households (aOR 1.36, 95% CI = 1.00 to 1.86), and infants with a Pakistani ethnic background (with mothers born in the UK [aOR 1.44, 95% CI = 1.06 to 1.94] and outside [aOR 1.42, 95% CI = 1.07 to 1.90]). During year 2, odds of amoxicillin prescribing were higher for infants with a Pakistani ethnic background (with mothers born in the UK [aOR 1.46, 95% CI = 1.10 to 1.94] and outside [aOR 1.56, 95% CI = 1.19 to 2.04]) and those born <39 weeks gestation (aOR 1.20, 95% CI = 1.00 to 1.45). Additional risk factors included caesarean delivery, congenital anomalies, overcrowding, birth season, and childcare attendance, with GP surgery explaining 7%-9% of variation.
Conclusion:
Socioeconomic status and ethnic background were associated with amoxicillin prescribing during childhood. Efforts to reduce RTI spread in household and childcare settings may reduce antibiotic prescribing in primary care.
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