title: Systemic antibiotic prescribing to paediatric outpatients in 5 European countries: a population-based cohort study.
abstract: BACKGROUND
  To describe the utilisation of antibiotics in children and adolescents across 5 European countries based on the same drug utilisation measures and age groups. Special attention was given to age-group-specific distributions of antibiotic subgroups, since comparison in this regard between countries is lacking so far.
  
  
  METHODS
  Outpatient paediatric prescriptions of systemic antibiotics during the years 2005-2008 were analysed using health care databases from the UK, the Netherlands, Denmark, Italy and Germany. Annual antibiotic prescription rates per 1,000 person years were estimated for each database and stratified by age (≤4, 5-9, 10-14, 15-18 years). Age-group-specific distributions of antibiotic subgroups were calculated for 2008.
  
  
  RESULTS
  With 957 prescriptions per 1000 person years, the highest annual prescription rate in the year 2008 was found in the Italian region Emilia Romagna followed by Germany (561), the UK (555), Denmark (481) and the Netherlands (294). Seasonal peaks during winter months were most pronounced in countries with high utilisation. Age-group-specific use varied substantially between countries with regard to total prescribing and distributions of antibiotic subgroups. However, prescription rates were highest among children in the age group ≤4 years in all countries, predominantly due to high use of broad spectrum penicillins.
  
  
  CONCLUSIONS
  Strong increases of antibiotic prescriptions in winter months in high utilising countries most likely result from frequent antibiotic treatment of mostly viral infections. This and strong variations of overall and age-group-specific distributions of antibiotic subgroups across countries, suggests that antibiotics are inappropriately used to a large extent.
authors.forename: Jakob
authors.initials: J
authors.lastname: Holstiege
authors.forename: Tania
authors.initials: T
authors.lastname: Schink
authors.forename: Mariam
authors.initials: M
authors.lastname: Molokhia
authors.forename: Giampiero
authors.initials: G
authors.lastname: Mazzaglia
authors.forename: Francesco
authors.initials: F
authors.lastname: Innocenti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Oteri
authors.forename: Irene
authors.initials: I
authors.lastname: Bezemer
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Poluzzi
authors.forename: Aurora
authors.initials: A
authors.lastname: Puccini
authors.forename: Sinna Pilgaard
authors.initials: SP
authors.lastname: Ulrichsen
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Sturkenboom
authors.forename: Gianluca
authors.initials: G
authors.lastname: Trifirò
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstr, 30, 28359 Bremen, Germany. garbe@bips.uni-bremen.de.
authors.forename: Edeltraut
authors.initials: E
authors.lastname: Garbe
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005060:Europe; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D010372:Pediatrics; D012621:Seasons
chemical_list: D000900:Anti-Bacterial Agents