Systemic antibiotic prescribing to paediatric outpatients in 5 European countries: a population-based cohort study

BMC Pediatrics

Edeltraut Garbe⁵  Gianluca Trifirò¹  Miriam C Sturkenboom⁷  Sinna Pilgaard Ulrichsen²  Aurora Puccini⁸  Elisabetta Poluzzi⁸  Irene Bezemer⁴  Alessandro Oteri⁷  Francesco Innocenti³  Giampiero Mazzaglia⁶  Mariam Molokhia⁹  Tania Schink⁵  Jakob Holstiege⁵ 

[1] Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Messina, Italy;Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus, Denmark;Agenzia regionale di sanità della Toscana, Via Dazzi, 1 - 50141 Florence, Italy;The PHARMO Institute, Van Deventerlaan 30-40, 3528 AE Utrecht, The Netherlands;Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstr. 30, 28359 Bremen, Germany;Health search, Italian College of General Practitioners, Via Sestese, 61 - 50141 Florence, Italy;Department of Medical Informatics, Erasmus University Medical Center, Dr. Molewaterplein, 50 3015 GE Rotterdam, The Netherlands;Department of Pharmacology, University of Bologna, Via Irnerio, 48, 40126 Bologna, Italy;NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Department of Primary Care and Public Health Sciences, Room 713, 7th Floor, Capital House Weston St, SE1 3QD London, UK

关键词: Electronic healthcare database;    Penicillins;    Macrolides;    Cephalosporins;    Prescription rate;    Paediatric;    Antibiotic resistance;    Drug utilisation study;   

Others  :  848399
DOI  :  10.1186/1471-2431-14-174

 received in 2014-02-18, accepted in 2014-06-30,  发布年份 2014

【 摘 要 】

Background

To describe the utilisation of antibiotics in children and adolescents across 5 European countries based on the same drug utilisation measures and age groups. Special attention was given to age-group-specific distributions of antibiotic subgroups, since comparison in this regard between countries is lacking so far.

Methods

Outpatient paediatric prescriptions of systemic antibiotics during the years 2005-2008 were analysed using health care databases from the UK, the Netherlands, Denmark, Italy and Germany. Annual antibiotic prescription rates per 1,000 person years were estimated for each database and stratified by age (≤4, 5-9, 10-14, 15-18 years). Age-group-specific distributions of antibiotic subgroups were calculated for 2008.

Results

With 957 prescriptions per 1000 person years, the highest annual prescription rate in the year 2008 was found in the Italian region Emilia Romagna followed by Germany (561), the UK (555), Denmark (481) and the Netherlands (294). Seasonal peaks during winter months were most pronounced in countries with high utilisation. Age-group-specific use varied substantially between countries with regard to total prescribing and distributions of antibiotic subgroups. However, prescription rates were highest among children in the age group ≤4 years in all countries, predominantly due to high use of broad spectrum penicillins.

Conclusions

Strong increases of antibiotic prescriptions in winter months in high utilising countries most likely result from frequent antibiotic treatment of mostly viral infections. This and strong variations of overall and age-group-specific distributions of antibiotic subgroups across countries, suggests that antibiotics are inappropriately used to a large extent.

【 授权许可】

   
2014 Holstiege et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Adriaenssens N, Coenen S, Versporten A, Muller A, Minalu G, Faes C, Vankerckhoven V, Aerts M, Hens N, Molenberghs G, Goossens H: European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe (1997-2009). J Antimicrob Chemother 2011, 66(Suppl 6):vi3-vi12.
• [2]Bruinsma N, Kristinsson KG, Bronzwaer S, Schrijnemakers P, Degener J, Tiemersma E, Hryniewicz W, Monen J, Grundmann H: Trends of penicillin and erythromycin resistance among invasive Streptococcus pneumoniae in Europe. J Antimicrob Chemother 2004, 54:1045-1050.
• [3]Jones ME, Karlowsky JA, Draghi DC, Thornsberry C, Sahm DF, Bradley JS: Rates of antimicrobial resistance among common bacterial pathogens causing respiratory, blood, urine, and skin and soft tissue infections in pediatric patients. Eur J Clin Microbiol Infect Dis 2004, 23:445-455.
• [4]Bronzwaer SL, Cars O, Buchholz U, Molstad S, Goettsch W, Veldhuijzen IK, Kool JL, Sprenger MJ, Degener JE: A European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis 2002, 8:278-282.
• [5]Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD: Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010, 340:c2096.
• [6]Goossens H, Ferech M, Vander SR, Elseviers M: Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005, 365:579-587.
• [7]Arroll B: Antibiotics for upper respiratory tract infections: an overview of Cochrane reviews. Respir Med 2005, 99:255-261.
• [8]Smith SM, Fahey T, Smucny J, Becker LA: Antibiotics for acute bronchitis. Cochrane Database Syst Rev 2014, 3:CD000245.
• [9]Spinks A, Glasziou PP, Del Mar CB: Antibiotics for sore throat. Cochrane Database Syst Rev 2013, 11:CD000023.
• [10]Venekamp RP, Sanders S, Glasziou PP, Del Mar CB, Rovers MM: Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2013, 1:CD000219.
• [11]Schneider-Lindner V, Quach C, Hanley JA, Suissa S: Secular trends of antibacterial prescribing in UK paediatric primary care. J Antimicrob Chemother 2011, 66:424-433.
• [12]Clavenna A, Bonati M: Differences in antibiotic prescribing in paediatric outpatients. Arch Dis Child 2011, 96:590-595.
• [13]de Jong J, van den Berg PB, de Vries TW, de Jong-van den Berg LT: Antibiotic drug use of children in the Netherlands from 1999 till 2005. Eur J Clin Pharmacol 2008, 64:913-919.
• [14]Gagliotti C, Morsillo F, Resi D, Milandri M, Moro ML: A three-year population-based study of antibiotic treatments for children. Acta Paediatr 2005, 94:1502-1504.
• [15]Högberg L, Oke T, Geli P, Lundborg CS, Cars O, Ekdahl K: Reduction in outpatient antibiotic sales for pre-school children: interrupted time series analysis of weekly antibiotic sales data in Sweden 1992-2002. J Antimicrob Chemother 2005, 56:208-215.
• [16]Lusini G, Lapi F, Sara B, Vannacci A, Mugelli A, Kragstrup J, Bjerrum L: Antibiotic prescribing in paediatric populations: a comparison between Viareggio, Italy and Funen, Denmark. Eur J Public Health 2012, 19:434-438.
• [17]Sturkenboom MC, Verhamme KM, Nicolosi A, Murray ML, Neubert A, Caudri D, Picelli G, Sen EF, Giaquinto C, Cantarutti L, Baiardi P, Felisi MG, Ceci A, Wong IC: Drug use in children: cohort study in three European countries. BMJ 2008, 337:a2245.
• [18]Holstiege J, Garbe E: Systemic antibiotic use among children and adolescents in Germany: a population-based study. Eur J Pediatr 2013, 172(6):787-795.
• [19]Marra F, Monnet DL, Patrick DM, Chong M, Brandt CT, Winters M, Kaltoft MS, Tyrrell GJ, Lovgren M, Bowie WR: A comparison of antibiotic use in children between Canada and Denmark. Ann Pharmacother 2007, 41:659-666.
• [20]Otters HB, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koes BW: Trends in prescribing antibiotics for children in Dutch general practice. J Antimicrob Chemother 2004, 53:361-366.
• [21]Coloma PM, Schuemie MJ, Trifiro G, Gini R, Herings R, Hippisley-Cox J, Mazzaglia G, Giaquinto C, Corrao G, Pedersen L, LJ v d, Sturkenboom M: Combining electronic healthcare databases in Europe to allow for large-scale drug safety monitoring: the EU-ADR Project. Pharmacoepidemiol Drug Saf 2011, 20:1-11.
• [22]Stille CJ, Andrade SE, Huang SS, Nordin J, Raebel MA, Go AS, Chan KA, Finkelstein JA: Increased use of second-generation macrolide antibiotics for children in nine health plans in the United States. Pediatrics 2004, 114:1206-1211.
• [23]Cars O, Molstad S, Melander A: Variation in antibiotic use in the European Union. Lancet 2001, 357:1851-1853.
• [24]Grigoryan L, Burgerhof JG, Degener JE, Deschepper R, Lundborg CS, Monnet DL, Scicluna EA, Birkin J, Haaijer-Ruskamp FM: Attitudes, beliefs and knowledge concerning antibiotic use and self-medication: a comparative European study. Pharmacoepidemiol Drug Saf 2007, 16:1234-1243.
• [25]Napolitano F, Izzo MT, Di GG, Angelillo IF: Public knowledge, attitudes, and experience regarding the use of antibiotics in Italy. PLoS One 2013, 8:e84177.
• [26]Atti ML C d, Massari M, Bella A, Boccia D, Filia A, Salmaso S: Clinical, social and relational determinants of paediatric ambulatory drug prescriptions due to respiratory tract infections in Italy. Eur J Clin Pharmacol 2006, 62:1055-1064.
• [27]SWAB: NethMap 2010 - Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands. NethMap 2010. http://www.swab.nl/swab/cms3.nsf/uploads/35ACD3A546C31716C12578BF002EDC4F/$FILE/NethMap2011.pdf webcite
• [28]Plasschaert AI, Rovers MM, Schilder AG, Verheij TJ, Hak E: Trends in doctor consultations, antibiotic prescription, and specialist referrals for otitis media in children: 1995-2003. Pediatrics 2006, 117:1879-1886.
• [29]American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media: Diagnosis and management of acute otitis media. Pediatrics 2004, 113:1451-1465.
• [30]NICE Short Clinical Guidelines Technical Team (2008): Respiratory tract infections – antibiotic prescribing. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. London: National Institute for Health and Clinical Excellence; 2008.
• [31]Chiappini E, Regoli M, Bonsignori F, Sollai S, Parretti A, Galli L, de Martino M: Analysis of different recommendations from international guidelines for the management of acute pharyngitis in adults and children. Clin Ther 2011, 33:48-58.
• [32]Hersh AL, Jackson MA, Hicks LA: Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics 2013, 132:1146-1154.
• [33]Leclercq R, Courvalin P: Resistance to macrolides and related antibiotics in Streptococcus pneumoniae. Antimicrob Agents Chemother 2002, 46:2727-2734.
• [34]Malhotra-Kumar S, Lammens C, Coenen S, Van HK, Goossens H: Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study. Lancet 2007, 369:482-490.
• [35]Piovani D, Clavenna A, Cartabia M, Bonati M: The regional profile of antibiotic prescriptions in Italian outpatient children. Eur J Clin Pharmacol 2012, 68:997-1005.
• [36]Trifiro G, Calogero G, Ippolito FM, Cosentino M, Giuliani R, Conforti A, Venegoni M, Mazzaglia G, Caputi AP: Adverse drug events in emergency department population: a prospective Italian study. Pharmacoepidemiol Drug Saf 2005, 14:333-340.
• [37]Danish Health and Medicines Authority: Reimbursement. Denmark: Danish Health and Medicines Authority; 2012 [updated April 24, 2012]. 2013. Available from: http://laegemiddelstyrelsen.dk/ftp-upload/recept_lm_gen_uklaus_til.pdf webcite