JAC Advance Access originally published online on January 16, 2004
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Journal of Antimicrobial Chemotherapy (2004) 53, 361-366
© 2004 The British Society for Antimicrobial Chemotherapy
Trends in prescribing antibiotics for children in Dutch general practice
1 Department of General Practice, Ff305, P.O. Box 1738, Erasmus MC, University Medical Center Rotterdam, 3000 DR Rotterdam; 2 NIVEL, Netherlands Institute for Health Services Research; 3 Department of Paediatrics, Erasmus MC, University Medical Center/Sophia Childrens Hospital, Rotterdam, The Netherlands
Received 15 August 2003; returned 13 October 2003; revised 6 November 2003; accepted 8 November 2003
Objective: To assess changes in antibiotic prescribing patterns for children between 1987 and 2001, and to identify general practice characteristics associated with higher antibiotic prescribing rates.
Methods: Cross-sectional national survey of Dutch general practice in 1987 and 2001. Data were used for all children aged 0–17 years; 86 577 children in 103 participating practices in 1987, and 76 010 children in 90 participating practices in 2001. Population-based, contact-based and disease-based antibiotic prescription rates were evaluated by age, gender and diagnosis. Practice characteristics associated with inappropriate broad-spectrum antibiotic prescription were identified.
Results: Population-based prescription rates decreased from 300/1000 children (95% CI, 292–307) in 1987 to 232/1000 children in 2001 (95% CI, 228–235). In 1987, the contact-based prescription rate was 108/1000 contacts (95% CI, 106–111) and this was somewhat similar in 2001: 103/1000 contacts (95% CI, 101–105). In 2001, increased disease-based prescription rates were observed for acute otitis media, acute bronchitis, acute upper airway infections, acute tonsillitis and cough. Overall, non-recommended broad-spectrum antibiotics were prescribed more often in 2001 than in 1987 (87% in 1987 versus 90% in 2001, P < 0.001). Adjusted for other practice characteristics, general practitioners in single-handed practices prescribed 58% more broad-spectrum antibiotics inappropriately for upper airway infections than general practitioners in group practices.
Conclusion: Antibiotic prescribing in children is still relatively low in the Netherlands. However, the prescription of broad-spectrum antibiotics for inappropriate diagnoses has increased, an unfavourable trend given the emerging bacterial resistance. Single-handed practices should especially be targeted to improve antibiotic prescribing in children.
Keywords: antibiotic prescription, children, general practice, cross-sectional study
* Corresponding author. Tel: +31-10-408-9427; Fax: +31-10-463-2127; E-mail: j.otters{at}erasmusmc.nl
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