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Prescribing Antibiotics for Children with Acute Conditions in Public Primary Care Clinics in Singapore: A
Vivien Min Er Lee1,2, Si Hui Low3, Sky Wei Chee Koh1,2,3
1Division of Family Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
Insights
Antibiotic prescribing for children in Singapore decreased during the pandemic. However, appropriate antibiotic use for common infections like otitis media remains low, indicating a need for local guidelines and stewardship programs.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Antibiotic prescription data for children in Singapore's primary care are scarce, hindering effective healthcare policy development.
- Benchmarking current practices against international standards is crucial for antimicrobial stewardship.
Purpose of the Study:
- To analyze antibiotic prescription patterns in children visiting Singaporean public primary care clinics from 2018-2021.
- To evaluate the appropriateness of antibiotic prescribing using WHO AWaRe classification and established quality indicators.
Main Methods:
- Retrospective cohort study of 831,669 pediatric polyclinic visits (aged <18 years) between 2018 and 2021.
- Categorization of antibiotic prescriptions using the World Health Organization's Access, Watch, Reserve (WHO AWaRe) classification.
- Assessment of prescribing appropriateness against European Surveillance of Antimicrobial Consumption Network (ESAC-Net) and National Institute for Health and Care Excellence (NICE) guidelines.
Main Results:
- A significant reduction in monthly antibiotic prescriptions was observed during the pandemic years (2020-2021) compared to pre-pandemic (2018-2019).
- Over 95% of prescriptions for acute conditions were classified under the WHO AWaRe "Access" group.
- Antibiotic prescribing for otitis media (55.2%) significantly exceeded the quality indicator (0-20%).
- Appropriate antibiotic use for acute respiratory infections (51.3%) and otitis media (49.4%) was low, falling short of the 80-100% quality indicator target.
Conclusions:
- While pandemic measures reduced overall antibiotic use, significant gaps in appropriate prescribing for pediatric infections persist in Singapore's primary care.
- Development of local, evidence-based primary care antibiotic guidelines is urgently needed.
- Strengthening antibiotic stewardship programs is essential to improve prescribing practices and combat antimicrobial resistance.
Abstract:
Data on primary care antibiotic prescription practices for children in Singapore, which are essential for health care policy, are lacking. We aimed to address this gap and to benchmark prescription practices against international standards. A retrospective cohort database study on antibiotic prescriptions for children (aged < 18 years) who visited six public primary care clinics in Singapore between 2018 and 2021 was conducted. Data were categorised according to the World Health Organization's Access, Watch, Reserve (WHO AWaRe) classification. Quality indicators from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) and the National Institute for Health and Care Excellence (NICE) guidelines were used as a measure of appropriateness of antibiotic prescribing at the individual and overall patient level. In 831,669 polyclinic visits by children between 2018 and 2021, there was a significant reduction in mean antibiotics prescribed per month during pandemic years (2020-2021) compared to pre-pandemic (2018-2019) (MD 458.3, 95% CI 365.9-550.7). Most prescriptions (95.8%) for acute conditions fell within the WHO AWaRe "Access" group. Antibiotic prescription significantly exceeded (55.2%) the relevant quality indicator for otitis media (0-20%). The proportion of children receiving appropriate antibiotics for acute respiratory infections (n = 4506, 51.3%) and otitis media (n = 174, 49.4%) was low compared to the quality indicator (80-100%). There is a need to develop local evidence-based primary care antibiotic guidelines, as well as to support the development of stewardship programmes.
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