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Using Prescription Patterns in Primary Care to Derive New Quality Indicators for Childhood Community Antibiotic Prescribing

de Bie, Sandra MD, PhD; Kaguelidou, Florentia MD, PhD; Verhamme, Katia M. C. MD, PhD; De Ridder, Maria MSc, PhD; Picelli, Gino MSc; Straus, Sabine M. J. M. MD, PhD; Giaquinto, Carlo MD, PhD; Stricker, Bruno H. MB, PhD; Bielicki, Julia MD, PhD; Sharland, Mike MD, FRCPCH; Sturkenboom, Miriam C. J. M. PharmD, PhDon behalf of the ARPEC study

The Pediatric Infectious Disease Journal: December 2016 - Volume 35 - Issue 12 - p 1317–1323
doi: 10.1097/INF.0000000000001324
Antimicrobial Reports

Background: To describe patterns of antibiotic outpatient use in 3 European countries, including 2 new pediatric-specific quality indicators (QIs).

Methods: 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.

Results: 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.

Conclusions: 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.

Accepted for publication April 26, 2016.

This study has received co-funding from the European Union in the framework of the Health Programme. ARPEC Project A 2009-11-01.

The authors B. and F.K. are co-first authors and contributed equally to this study. All authors were responsible for study concept and design, interpretation of data, critical revision of the manuscript for important intellectual content and approval of final manuscript for submission.

The authors have no conflicts of interest to disclose.

Address for correspondence: Katia M. C. Verhamme, MD, PhD, Department of Medical Informatics, Erasmus University Medical Centre, Room Ee-2159, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail:

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