A Danish Nationwide Drug Utilization Study

Background: We aimed to describe the use of systemic antibiotics among children in Denmark. Methods: National data on drug use in Denmark were extracted from the Danish National Prescription Database. We used prescription data for all children in Denmark aged 0 to 11 years from January 1, 2000 to December 31, 2012. Results: We obtained data on 5,884,301 prescriptions for systemic antibiotics issued to 1,206,107 children. The most used single substances were phenoxymethylpenicillin (45%), amoxicillin (34%) and erythromycin (6%). The highest incidence rate of antibiotic treatment episodes was observed among children younger than 2 at 827 per 1000 children in 2012. Incidence rates were relatively stable throughout the study period. One-year prevalences in 2012 were 485, 363 and 190 per 1000 children among children aged 0–1, 2–4 and 5–11, respectively. A gradual shift from narrow-spectrum penicillin V to the broader-spectrum amoxicillin was found among children younger than 5. The use of macrolides decreased slightly, especially among those aged 0–1. Minor regional differences were noted, with somewhat higher use in the Capital Region. Skewness in use was most notable among those aged 0–1. There was little evidence of heavy users. Conclusion: Prescribing rate of antibiotics to children in Denmark remained stable at a high level from 2000 to 2012. An increase in the use of broad-spectrum beta-lactam penicillin was noted, but otherwise the prescribing pattern adhered well to National guidelines with respect to choice of antibiotics.

[1]  M. Nitsche,et al.  Antibiotics for acute otitis media in children. , 2015, Medwave.

[2]  Jing Zhang,et al.  WHO: draft global action plan on antimicrobial resistance , 2015 .

[3]  Arti Kapi The evolving threat of antimicrobial resistance: Options for action , 2014 .

[4]  Scott M. Brue,et al.  Age and sex patterns of drug prescribing in a defined American population. , 2013, Mayo Clinic proceedings.

[5]  M. Bonati,et al.  Drug use profile in outpatient children and adolescents in different Italian regions , 2013, BMC Pediatrics.

[6]  Richard Smith,et al.  The true cost of antimicrobial resistance , 2013, BMJ.

[7]  E. Garbe,et al.  Systemic antibiotic use among children and adolescents in Germany: a population-based study , 2013, European Journal of Pediatrics.

[8]  Svein Gjelstad,et al.  Are children carrying the burden of broad-spectrum antibiotics in general practice? Prescription pattern for paediatric outpatients with respiratory tract infections in Norway , 2013, BMJ Open.

[9]  P. Larsen,et al.  Multimorbidity and Blood Pressure Control in 37 651 Hypertensive Patients From Danish General Practice , 2012, Journal of the American Heart Association.

[10]  G. Dinant,et al.  Oral and topical antibiotic prescriptions for children in general practice , 2012, Archives of Disease in Childhood.

[11]  J. Søndergaard,et al.  The Danish Model for Improvement of Diabetes Care in General Practice: Impact of Automated Collection and Feedback of Patient Data , 2012, International journal of family medicine.

[12]  V. Hentgen,et al.  Decreased paediatric antibiotic consumption in France between 2000 and 2010 , 2012, Scandinavian journal of infectious diseases.

[13]  G. Cordoba,et al.  Macrolide overuse for treatment of respiratory tract infections in general practice. , 2011, Danish medical bulletin.

[14]  C. Pedersen,et al.  The Danish Civil Registration System , 2011, Scandinavian journal of public health.

[15]  J. Hallas,et al.  The Danish National Prescription Registry , 2011, Scandinavian journal of public health.

[16]  S. Suissa,et al.  Secular trends of antibacterial prescribing in UK paediatric primary care. , 2011, The Journal of antimicrobial chemotherapy.

[17]  M. Bonati,et al.  Differences in antibiotic prescribing in paediatric outpatients , 2011, Archives of Disease in Childhood.

[18]  J. Hallas,et al.  [Children prefer bottled amoxicillin]. , 2010, Ugeskrift for laeger.

[19]  Alastair D Hay,et al.  Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis , 2010, BMJ : British Medical Journal.

[20]  M. Bonati,et al.  Drug prescriptions to outpatient children: a review of the literature , 2009, European Journal of Clinical Pharmacology.

[21]  H. Goossens,et al.  Antibiotic consumption and link to resistance. , 2009, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[22]  J. Bartlett,et al.  Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[23]  Paul Little,et al.  Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance , 2008, BMJ : British Medical Journal.

[24]  M. V. van Driel,et al.  Differences Among International Pharyngitis Guidelines: Not Just Academic , 2007, The Annals of Family Medicine.

[25]  A. Engeland,et al.  Age- and gender-specific antibacterial prescribing in Norway. , 2007, The Journal of antimicrobial chemotherapy.

[26]  G. Tyrrell,et al.  A Comparison of Antibiotic Use in Children Between Canada and Denmark , 2007, The Annals of pharmacotherapy.

[27]  A. Schilder,et al.  Trends in Doctor Consultations, Antibiotic Prescription, and Specialist Referrals for Otitis Media in Children: 1995–2003 , 2006, Pediatrics.

[28]  G. Miller,et al.  Children and Antibiotics: Analysis of Reduced Use, 1996–2001 , 2006, Medical care.

[29]  K. Ekdahl,et al.  Penicillin-resistant pneumococci in Sweden 1997-2003: increased multiresistance despite stable prevalence and decreased antibiotic use. , 2006, Microbial drug resistance.

[30]  Jesper Hallas,et al.  Templates for analysis of individual-level prescription data. , 2006, Basic & clinical pharmacology & toxicology.

[31]  A. Bartelds,et al.  A Case-Control Study of Acute Respiratory Tract Infection in General Practice Patients in The Netherlands , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[32]  O. Cars,et al.  Reduction in outpatient antibiotic sales for pre-school children: interrupted time series analysis of weekly antibiotic sales data in Sweden 1992-2002. , 2005, The Journal of antimicrobial chemotherapy.

[33]  H. Goossens,et al.  Outpatient antibiotic use in Europe and association with resistance: a cross-national database study , 2005, The Lancet.

[34]  P. Laippala,et al.  Effect of macrolide consumption on erythromycin resistance in Streptococcus pyogenes in Finland in 1997-2001. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[35]  A. Go,et al.  Reduction in antibiotic use among US children, 1996-2000. , 2003, Pediatrics.

[36]  O. Cars,et al.  A European study on the relationship between antimicrobial use and antimicrobial resistance. , 2002, Emerging infectious diseases.

[37]  H. Sørensen,et al.  A population-based study of antibiotic prescriptions for Danish children. , 1999, The Pediatric infectious disease journal.

[38]  P Huovinen,et al.  The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. , 1997, The New England journal of medicine.

[39]  Organización Mundial de la Salud Guidelines for ATC classification and DDD assignment , 1996 .