title: Trends in prescribing antibiotics for children in Dutch general practice.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Practice, Ff305, P.O. Box 1738, Erasmus MC, University Medical Center Rotterdam, 3000 DR Rotterdam. j.otters@erasmusmc.nl
authors.forename: Hanneke B M
authors.initials: HB
authors.lastname: Otters
authors.forename: Johannes C
authors.initials: JC
authors.lastname: van der Wouden
authors.forename: Francois G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Lisette W A
authors.initials: LW
authors.lastname: van Suijlekom-Smit
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003625:Data Collection; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000639:trends; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011153:Population; D012737:Sex Factors
chemical_list: D000900:Anti-Bacterial Agents