Abstract
BackgroundPrescribing of systemic antibiotics in general and of cephalosporins in particular in German paediatric outpatients has previously been reported to be higher than in other European countries.AimOur objective was to assess recent trends in antibiotic prescribing in German children.MethodsThis study was conducted as consecutive annual cross-sectional analyses and included all children aged 0–14 years (n = 9,389,183 in 2018) covered by statutory health insurance in Germany. Annual antibiotic prescription rates from 2010 to 2018 were calculated for the age groups 0–1, 2–5, 6–9 and 10–14 years. Poisson regression was used to estimate trends of prescription rates by age group and antibiotic subgroup.ResultsOverall, the age-standardised antibiotic prescription rate decreased significantly by 43% from 746 prescriptions per 1,000 persons in 2010 to 428 per 1,000 in 2018 (p < 0.001). Reductions were most pronounced in the age groups 0–1 year (−50%) and 2–5 years (−44%). The age group 2–5 years exhibited the highest prescription rate with 683 per 1,000 in 2018 (0–1 year: 320/1,000; 6–9 years: 417/1,000; 10–14 years: 273/1,000). Cephalosporins (second and third generation) accounted for 32% of prescribed antibiotics.ConclusionsMarked reductions in antibiotic prescribing during the last decade indicate a change towards more judicious paediatric prescribing habits. Compared with other European countries, however, prescribing of second- and third-generation cephalosporins remains high in Germany, suggesting frequent first-line use of these substances for common respiratory infections. Considerable regional variations underline the need for regionally targeted interventions.
Highlights
Antibiotic resistance is considered an emerging threat to global public health
A study of outpatient antibiotic prescriptions from the Netherlands showed that the vast majority of antibiotics are prescribed as single course [13]
Prescription rates are robust towards alterations of dosage per prescription over time, which may arise from changes in the prescribing practice for specific drugs or changes in the mix of antibiotics used [14]
Summary
Antibiotic resistance is considered an emerging threat to global public health. Among other factors, exposure to antibiotics is a leading cause for the proliferation of resistant bacterial strains on individual [1] and population level [2]. Of particular concern were the high prescription rates of cephalosporins, suggesting common usage of these substances as first-line treatment of childhood infections in the German paediatric outpatient setting. This is in conflict with evidence-based practice guidelines for common childhood infections [7,8] and may further accelerate the emergence of antibiotic resistance among Gram-negative bacteria, including the selection of extended-spectrum beta-lactamases (ESBL) [9]. Compared with other European countries, prescribing of second- and third-generation cephalosporins remains high in Germany, suggesting frequent first-line use of these substances for common respiratory infections. Considerable regional variations underline the need for regionally targeted interventions
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