Large differences in prescribing of antibiotics for children and adolescents in five European countries

Antibiotics are most often prescribed for children and adolescents in Italy - followed by Germany, England, and Denmark. In the Netherlands, the prescription rate is the lowest by far - it amounts to one-third of that in Italy. In all five countries, under-four-year-olds receive antibiotics most often. This was shown in a study of five European countries analyzing data from 23 million children and adolescents from 2005 to 2008. Professor Edeltraut Garbe from the Leibniz Institute for Prevention Research and Epidemiology - BIPS is lead author of the study published in the journal BMC Pediatrics.

Antibiotics are prescribed often, too often, as resistant bacterial strains are increasing worldwide, causing antibiotics to lose their effect. To counteract this trend, it is fundamental to understand how antibiotics are prescribed. In the published study, carried out within the framework of the EU project Aritmo about side effects of different classes of drugs, scientists have illuminated the frequency but also the type of antibiotic prescribed at various ages between zero and 18 years. The comparability of results renders the study unique in antibiotic research; methods, studied age groups and the study period are consistent in all five countries.

The study revealed high prescription rates in Italy, Germany, England, and Denmark and a low one in the Netherlands. Previous studies have already shown that the Netherlands are pioneers in the careful use of antibiotics in Europe. In the Netherlands, there is a strict regulation policy for medicines for infectious diseases, and there are strong efforts to promote prescribing guidelines to combat bacterial resistance.

The scientists suspect that the differences are not caused by varying infection frequencies in the countries but instead are due to country-specific prescribing behaviors. It is believed that antibiotics are prescribed not only for bacterial but also viral infections. This is supported by the observation that there are seasonal peaks in the prescription of antibiotics. It is highest in winter, especially in countries with a high prescription rate. This suggests that antibiotics are used for viral infections and are thus misapplied. Unlike bacterial infections, viral infections increase mainly during the winter months.

"In particular, respiratory infections and ear infections in children are often already treated with antibiotics at the first medical contact," explains Professor Garbe, head of the Department of Clinical Epidemiology at BIPS. "However, many studies show that, as a general rule, antibiotics should only be prescribed if symptoms do not improve during the first days of the disease. Their widespread utilization promotes the emergence of multi-resistant germs and exposes children to the unnecessary risk of side effects."

Furthermore, the study shows that the types of prescribed antibiotics vary in the five countries in general, but there are also wide variations in the age groups studied. It can be assumed that the most appropriate antibiotic is not always used for a disease. In all countries, except Denmark, broad-spectrum antibiotics are the largest group of prescribed antibiotics. This applies particularly to the age group of under-four-year-olds in all five countries. Narrow-spectrum antibiotics are used most frequently in Denmark. The study also shows that the types of antibiotics which increasingly promote resistance are prescribed often, and that they are used too early.

Publication:
"Systemic antibiotic prescribing to paediatric outpatients in 5 European countries: a population-based cohort study"
Holstiege J, Schink T, Molokhia M, Mazzaglia G, Innocenti F, Oteri A, Bezemer I, Poluzzi E, Puccini A, Ulrichsen S P, Sturkenboom M C, Trifirò G and Garbe E. BMC Pediatrics. 2014;14:174. doi:10.1186/1471-2431-14-174. www.biomedcentral.com/1471-2431/14/174

Further Information:
www.aritmo-project.org

Contact:
Leibniz Institute for Prevention Research and Epidemiology – BIPS
Prof. Dr. Edeltraut Garbe
Tel. +49/(0)421/218-56862
E-Mail garbe(at)bips.uni-bremen.de

Dr. Tania Schink
Tel. +49/(0)421/218-56865
E-Mail schink(at)bips.uni-bremen.de

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