Using Prescription Patterns in Primary Care to Derive New Quality Indicators for Childhood Community Antibiotic Prescribing.
To describe patterns of antibiotic outpatient use in 3 European countries, including 2 new pediatric-specific quality indicators (QIs).



A cohort study was conducted, 2001-2010, using electronic primary care records of 2,196,312 children up to 14 (Pedianet, Italy) or 18 years (The Health Improvement Network, United Kingdom; Integrated Primary Care Information database, The Netherlands) contributing 12,079,620 person-years. Prevalence rates of antibiotic prescribing per year were calculated and antibiotics accounting (drug utilization) for 90% of all antibiotic prescriptions were identified (drug utilization 90% method). The ratio between users of broad to narrow-spectrum penicillins, cephalosporins and macrolides (B/N ratio) and 2 pediatric-specific QIs: the proportion of amoxicillin users (amoxicillin index) and the ratio between users of amoxicillin to broad-spectrum penicillins, cephalosporins and macrolides (A/B ratio) were determined.



The overall annual prevalence of antibiotic prescriptions was 18.0% in the Netherlands, 36.2% in the United Kingdom and 52.0% in Italy. Use was maximal in the first years of life. The number of antibiotics accounting for the drug utilization 90% was comparable. The B/N ratio varied widely from 0.3 to 74.7. The amoxicillin index was highest in the Netherlands and the United Kingdom (50-60%), lowest in Italy (30%) and worsened over time in the United Kingdom and Italy. The A/B ratio in 2010 was 0.3 in Italy, 1.7 in the Netherlands and 5.4 in the United Kingdom.



The patterns of antibiotic prescribing varied highly with age and country. The pediatric-specific QIs combined with the total prevalence rate of use provide a clear picture of the trends of community childhood antibiotic prescribing, allowing monitoring of the impact of policy interventions.
From the *Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; †Department of Pediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, APHP; Univ Paris 7-Diderot, Sorbonne Paris Cité, EA08; INSERM CIC1426, Paris, France; ‡International Pharmaco-epidemiology and Pharmaco-economics Research Center, Desio, Italy; §Medicines Evaluations Board, Utrecht, The Netherlands; ¶Società Italiana di Medicina Generale, Florence, Italy; ‖Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; and **Paediatric Infectious Diseases Research Group, St George's University London, London, United Kingdom.
Sandra
S
de Bie
Florentia
F
Kaguelidou
Katia M C
KM
Verhamme
Maria
M
De Ridder
Gino
G
Picelli
Sabine M J M
SM
Straus
Carlo
C
Giaquinto
Bruno H
BH
Stricker
Julia
J
Bielicki
Mike
M
Sharland
Miriam C J M
MC
Sturkenboom
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010045:Outpatients; D017891:Pharmacoepidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents