Does attendance in outdoor kindergartens reduce the use of antibiotics in children?

Abstract

To determine whether children enrolled in rural outdoor kindergartens had a lower risk of redeeming at least one prescription for antibiotics compared to children enrolled in urban conventional kindergartens, and if type of antibiotics prescribed differed according to kindergarten type. Two Danish municipalities provided data including civil registration numbers from children enrolled in a rural outdoor kindergarten in 2011-2019, and a subsample of all children enrolled in urban conventional kindergartens in the same period. Civil registration numbers were linked to individual-level information on redeemed prescriptions for antibiotics from the Danish National Prescription Registry. Regression models were performed on 2,132 children enrolled in outdoor kindergartens, and 2,208 children enrolled in conventional kindergartens. There was no difference between groups in risk of redeeming at least one prescription for all types of antibiotics (Adjusted Risk Ratio: 0.97 (95% Confidence Intervals 0.93,1.02, p=0.26)). Similarly, there were no differences between kindergarten type and risk of redeeming at least one prescription for systemic, narrow-spectrum systemic antibacterial, broad-spectrum systemic antibacterial, or topical antibiotics. Compared to children who were enrolled in conventional kindergartens, children who were enrolled in outdoor kindergartens did not have a lower risk of redeeming prescriptions for any type of antibiotics.