title: Antibiotic Use in Children - A Cross-National Analysis of 6 Countries.
abstract: To describe the rates of pediatric antibiotic use across 6 countries on 3 continents.
  
  
  
  Cross-national analysis of 7 pediatric cohorts in 6 countries (Germany, Italy, South Korea, Norway, Spain, and the US) was performed for 2008-2012. Antibiotic dispensings were identified and grouped into subclasses. We calculated the rates of antimicrobial prescriptions per person-year specific to each age group, comparing the rates across different countries.
  
  
  
  A total of 74 744 302 person-years from all participating centers were included in this analysis. Infants in South Korea had the highest rate of antimicrobial consumption, with 3.41 prescribed courses per child-year during the first 2 years of life. This compares with 1.6 in Lazio, Italy; 1.4 in Pedianet, Italy; 1.5 in Spain; 1.1 in the US; 1.0 in Germany; and 0.5 courses per child-year in Norway. Of antimicrobial prescriptions written in Norway, 64.8% were for first-line penicillins, compared with 38.2% in Germany, 31.8% in the US, 27.7% in Spain, 25.1% in the Italian Pedianet population, 9.8% in South Korea, and 8% in the Italian Lazio population.
  
  
  
  We found substantial differences of up to 7.5-fold in pediatric antimicrobial use across several industrialized countries from Europe, Asia, and North America. These data reinforce the need to develop strategies to decrease the unnecessary use of antimicrobial agents.
authors.affiliation: Division of Infectious Diseases, Boston Children's Hospital, Boston, MA. Electronic address: ilan.youngster@childrens.harvard.edu.
authors.forename: Ilan
authors.initials: I
authors.lastname: Youngster
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Belleudi
authors.affiliation: Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Cantarutti
authors.affiliation: Health Services Research Unit, Center for Public Health Research, Valencia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Díez-Domingo
authors.affiliation: Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
authors.forename: Ursula
authors.initials: U
authors.lastname: Kirchmayer
authors.affiliation: Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Byung-Joo
authors.initials: BJ
authors.lastname: Park
authors.affiliation: Health Services Research Unit, Center for Public Health Research, Valencia, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Peiró
authors.affiliation: Health Services Research Unit, Center for Public Health Research, Valencia, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sanfélix-Gimeno
authors.affiliation: Wissenschaftliches Institut der AOK WIdO (Scientific Institute of the AOK), Berlin, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Schröder
authors.affiliation: Wissenschaftliches Institut der AOK WIdO (Scientific Institute of the AOK), Berlin, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Schüssel
authors.affiliation: Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea.
authors.forename: Ju-Young
authors.initials: JY
authors.lastname: Shin
authors.affiliation: Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea.
authors.forename: Sun Mi
authors.initials: SM
authors.lastname: Shin
authors.affiliation: Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Gunnar Skov
authors.initials: GS
authors.lastname: Simonsen
authors.affiliation: Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Hege Salvesen
authors.initials: HS
authors.lastname: Blix
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Angela
authors.initials: A
authors.lastname: Tong
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Trifirò
authors.affiliation: Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Tomer
authors.initials: T
authors.lastname: Ziv-Baran
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Seoyoung C
authors.initials: SC
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D007223:Infant; D038622:Internationality; D007558:Italy; D008297:Male; D009664:Norway; D056910:Republic of Korea; D012189:Retrospective Studies; D013030:Spain; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; children; cross-national analysis