title: Utilisation of antibiotics in young children: opposite relationships to adult educational levels in Danish and Swedish counties.
abstract: BACKGROUND
  Antibiotic utilisation varies profoundly among and within countries, and the extent of antibiotic utilisation correlates with the frequency of bacterial resistance, particularly among children. Hence, it is important to assess which factors may influence prescribing. In addition to variations in morbidity, health-care organisation, drug regulatory and supply systems, prescriber's attitudes, parents' behaviour, attitudes and socio-economic positions seem important. We compared socio-economic position (educational level of adults) and antibiotic utilisation in children in the municipalities within a Danish and a Swedish county which are geographically close, have similar social and economic development, and similar drug regulatory and supply systems.
  
  
  METHODS
  Data on antibiotic utilisation (1998), expressed in defined daily doses per 1000 inhabitants per day (DDD/TID), were obtained from the Copenhagen County Health Insurance register and from the National Corporation of Swedish Pharmacies. Data on municipal educational levels were obtained from Statistics Denmark and Statistics Sweden.
  
  
  RESULTS
  The utilisation of antibiotics in 0- to 6-year-old children was higher in the Swedish than in the Danish county but varied between the municipalities within both the Swedish (9.6-17.7 DDD/TID) and the Danish (8.0-12.9 DDD/TID) counties. Most notably, utilisation rates correlated negatively with the education levels in the Danish (r=-0.539, P=0.021) but positively in the Swedish (r=+0.390, P=0.025) municipalities.
  
  
  CONCLUSIONS
  The observed variations in antibiotic prescribing may reflect different parental and/or prescriber attitudes towards use of antibiotics and they emphasise that antibiotic prescribing is influenced by factors other than the prevalence of bacterial infections. Relationships between socio-economic position (educational level) and drug utilisation should not be generalised from one area to another.
authors.affiliation: Department of Clinical Microbiology and Immunology, Lund University Hospital, 221 85, Lund, Sweden. eva.z.melander@skane.se
authors.forename: Eva
authors.initials: E
authors.lastname: Melander
authors.forename: Aase
authors.initials: A
authors.lastname: Nissen
authors.forename: Karin
authors.initials: K
authors.lastname: Henricson
authors.forename: Juan
authors.initials: J
authors.lastname: Merlo
authors.forename: Sigvard
authors.initials: S
authors.lastname: Mölstad
authors.forename: Jens P
authors.initials: JP
authors.lastname: Kampmann
authors.forename: Thor
authors.initials: T
authors.lastname: Lithman
authors.forename: Ebba Holme
authors.initials: EH
authors.lastname: Hansen
authors.forename: Arne
authors.initials: A
authors.lastname: Melander
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003718:Denmark; D004363:Drug Utilization; D004522:Educational Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D013548:Sweden
chemical_list: D000900:Anti-Bacterial Agents