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Trends in Antibiotic Use in Danish, Finnish, Norwegian and Swedish Children
Nils Skajaa1,2,3,4, Lise Gehrt3,4, Heta Nieminen5
1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Antibiotic use in children across four Nordic countries declined between 2006 and 2017. Significant variations persist, with Finland showing over double the antibiotic treatment rates compared to Norway, highlighting a need for targeted interventions.
Area of Science:
- Pediatric infectious disease epidemiology
- Public health policy and antibiotic stewardship
- Comparative healthcare research
Background:
- Antibiotic resistance is a growing global health concern.
- Understanding regional variations in antibiotic prescribing is crucial for effective stewardship.
- Northern European countries share similar healthcare systems, making them ideal for comparative analysis.
Purpose of the Study:
- To compare the incidence of systemic antibiotic use in children (0-14 years) across Denmark, Finland, Norway, and Sweden.
- To analyze trends in antibiotic treatment episodes over a decade (2006-2017).
- To identify differences in antibiotic class utilization among these countries.
Main Methods:
- A register-based study utilizing individual-level prescription data from national registers.
- Analysis of all redeemed outpatient prescriptions for systemic antibiotics in children aged 0-14 years from July 2006 to June 2017.
- Calculation of incidence rates and incidence rate ratios for antibiotic treatment episodes and specific antibiotic classes.
Main Results:
- In 2016/2017, antibiotic treatment rates per 1000 person-years varied significantly: Finland (429), Denmark (284), Sweden (219), and Norway (184).
- Finland exhibited over a 2-fold higher rate compared to Norway, with rate ratios of 2.33.
- Overall antibiotic use declined in all countries between 2006/2007 and 2016/2017, with reductions ranging from 29% (Norway) to 49% (Sweden).
Conclusions:
- Despite a general decline in antibiotic use among children in Northern Europe, substantial inter-country disparities remain.
- The significant differences in antibiotic consumption highlight opportunities for implementing targeted interventions in high-prescribing nations.
- Further research into the drivers of these variations could inform strategies to optimize antibiotic stewardship in pediatric populations.
Objective:
To compare the use of antibiotics in children in four Northern European countries.
Methods:
We conducted a register-based study based on individual-level prescription data from national prescription registers. We identified all redeemed outpatient prescriptions for systemic antibiotics in children aged 0-14 years from July 2006 to June 2017 in Denmark, Finland, Norway, and Sweden. We computed incidence rates and incidence rate ratios of treatment episodes with any antibiotic and different antibiotic classes.
Results:
In 2016/2017, the rates of antibiotic treatment episodes per 1000 person-years in children aged 0-14 years were 429, 284, 219, and 184 in Finland, Denmark, Sweden, and Norway, respectively, and the rate ratios (95% confidence intervals) compared with Norway were 2.33 (2.33-2.34), 1.54 (1.54-1.55), and 1.19 (1.19-1.20) in Finland, Denmark, and Sweden, respectively. The rate of antibiotic treatment episodes declined over time in all countries. The relative reductions in 2016/2017 compared with 2006/2007 were 36% in Finland, 40% in Denmark, 49% in Sweden, and 29% in Norway. Treatment episodes peaked between age 12 and 18 months. The most used antibiotic class was beta-lactamase sensitive penicillins among all children in Norway and Sweden and among children above two years in Denmark, while penicillins with extended spectrum were most used in Finland and among the youngest children in Denmark.
Conclusion:
In all countries, the use of antibiotics in children declined between 2006 and 2017. However, there were still considerable differences in antibiotic use between otherwise quite similar Nordic countries, with a more than 2-fold difference between the countries with the lowest and highest rates. Interventions to reduce the number of antibiotic treatment episodes in the countries with higher rates could reduce the total antibiotic use.
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