JAC Advance Access published online on January 16, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh062
© 2004 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of General
Practice, Ff305, P.O. Box 1738, Erasmus MC, University Medical Center
Rotterdam,
3000 DR Rotterdam;
* Corresponding author. E-mail: j.otters{at}erasmusmc.nl.
Received 15 August 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
Trends in prescribing antibiotics for children
in Dutch general practice
2 NIVEL,
Netherlands Institute for Health Services Research;
3 Department of Paediatrics, Erasmus
MC, University Medical Center/Sophia Childrens Hospital, Rotterdam,
The Netherlands
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