JAC Advance Access originally published online on May 16, 2005
Journal of Antimicrobial Chemotherapy 2005 56(1):208-215; doi:10.1093/jac/dki147
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Reduction in outpatient antibiotic sales for pre-school children: interrupted time series analysis of weekly antibiotic sales data in Sweden 1992–2002
1 Department of Epidemiology, Swedish Institute for Infectious Disease Control, Stockholm, Sweden; 2 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 3 Stockholm Group for Epidemic Modelling (S-GEM), Sweden; 4 Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance (STRAMA), Stockholm, Sweden; 5 Division of International Health Care and Research (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 6 Apoteket AB, Stockholm, Sweden; 7 Nordic School of Public Health, Göteborg, Sweden
Received 20 September 2004; returned 6 January 2005; revised 18 February 2005; accepted 5 April 2005
* Correspondence address. Department of Epidemiology, Swedish Institute for Infectious Disease Control, SE-171 82 Solna, Sweden. Tel: +46-8-457-23-84; Fax: +46-8-30-06-26; Email: liselotte.hogberg{at}smi.ki.se
Objectives: The aim of this study was to use detailed weekly data on outpatient antibiotic sales for pre-school children in Sweden to test for the significance of trends during 1992–2002. We also report on the special features found in weekly antibiotic data, and how the interrupted time series (ITS) design can adjust for this.
Methods: Weekly data on the total number of dispensed outpatient antibiotic prescriptions to pre-school children were studied, as well as the individual subgroups commonly used to treat respiratory tract infections in children: narrow-spectrum penicillins, broad-spectrum penicillins and macrolides. In parallel, monthly data of paracetamol sales of paediatric dosages were analysed to reflect trends in symptomatic treatment. An ITS model controlling for seasonality and autocorrelation was used to examine the datasets for significant level and trend shifts.
Results: A significant increase in mean and change in level could be found in the total antibiotic data in 1997, also reflected in broad-spectrum penicillin data where a similar trend break occurred in 1996. For macrolides, a trend break with a decrease in mean was noted in 1996, but no trend breaks were found in narrow-spectrum penicillin data. In contrast to the general decreasing trends in antibiotic sales, the yearly over-the-counter sales of paracetamol in paediatric preparations increased during the same period, with no identified trend breaks.
Conclusions: The overall decrease in antibiotic sales and increase in paediatric paracetamol sales might suggest that symptomatic treatment in the home has increased, as antibiotics are less commonly prescribed.
Keywords: segmented regression analysis , community antibiotic prescribing , paracetamol , prescription rates
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