Abstract
BackgroundIn China, there were few studies to estimate antibiotic use for children with upper respiratory infections at the national level. The aim of this study was to describe the antibiotic prescribing practice for children aged < 5 years old with upper respiratory infections (URIs) using a nationwide claims database.MethodsThis was a retrospective cross-sectional study using a sampled database from the China Health Insurance Research Association (CHIRA). Study subjects included children younger than 5 years with outpatient visits in 2015 that resulted in a diagnosis of a upper respiratory infection. We calculated the percentage of visits who received antibiotics, the proportion of injection formulations, the percentage of combined antibiotics and the proportion of each antibiotic class. The patterns of antibiotic prescription were also described by medical institution type, city level and geographical region.ResultsAmong the 92,821 visits, 27.1% were prescribed antibiotics, of which 27.0% received injection formulations. The rate of antibiotic prescribing varied by age group (P < 0.001), with the lowest (16.0%) in infants and the highest in patients at age 3 to < 4 years (29.9%) and age 4 to < 5 years (32.5%). The Midwestern region, underdeveloped cities and low-level hospitals represented relatively higher rates of prescribing antibiotics (P < 0.001) and higher proportions of injection dosage forms (P < 0.001). The most 3 common antibiotic classes prescribed of all visits with antibiotic prescriptions were the third-generation cephalosporins (34.9%), macrolides (24.3%), and the second-generation cephalosporins (23.3%).ConclusionsIn mainland China, the overall rate of antibacterial prescribing and the proportion of injection formulations prescribed in children under 5 years with URIs were at a low level, but still higher in underdeveloped regions and cities. Moreover, the overuse of the second and third generation cephalosporins, macrolides, remains a serious issue. Further efforts should be focused on reducing those non-first-line antibiotic prescribing and narrowing the gaps among regions and cities.
Highlights
In China, there were few studies to estimate antibiotic use for children with upper respiratory infections at the national level
In mainland China, the overall rate of antibacterial prescribing and the proportion of injection formulations prescribed in children under 5 years with upper respiratory infections (URIs) were at a low level, but still higher in underdeveloped regions and cities
There were 92,821 sampled ambulatory care visits for URIs from 59 cities included in the analysis. 73,638 outpatient visits were from the east region of China, which accounted for 79.3% of all visits
Summary
In China, there were few studies to estimate antibiotic use for children with upper respiratory infections at the national level. The aim of this study was to describe the antibiotic prescribing practice for children aged < 5 years old with upper respiratory infections (URIs) using a nationwide claims database. A prior study in US estimating potential rate of inappropriate outpatient antibiotic use had relied on estimates of bacterial prevalence and concluded that more than 50% of antibiotics for URIs were unnecessary [8]. Compared with European and American countries, the proportion of broad-spectrum antibiotics (second- and third generation cephalosporins and azithromycin, etc.) was still higher in China [15]. The antimicrobial resistance in key pathogens remains high in China and there were increasing rates of resistance to carbapenems in clinical isolates of Escherichia coli and Klebsiella pneumoniae during 2014–2017 [17]
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