Skip to main content
SpringerLink
Log in

Variation in antibiotic prescriptions: is area deprivation an explanation? Analysis of 1.2 million children in Germany

Infection volume 41, pages 121–127 (2013)Cite this article

Abstract

Purpose

Inadequate use of antibiotics can lead to problems such as resistance. Overuse is especially a problem for children, since they are more affected by acute (often virus-caused) infections. While the problem has been addressed internationally over the past several years, regional variations in prescriptions are striking. Therefore, the present study aims to analyze regional variations in antibiotic prescription on a district level in Germany and tries to identify reasons for those variations through adding possible influencing factors to the analysis on individual and district levels.

Methods

We analyzed 1.2 million children insured in a German health insurance fund. Antibiotic prescriptions were quantified in 2010 and reasons for prescriptions were analyzed in multilevel regressions based on the district of residence, regional deprivation, and age and sex of the child.

Results

Thirty-six percent of all children aged 0–17 years received an antibiotic prescription in 2010. In the south, prevalences are generally lower, and also to the very north. The highest prevalences are found in the close-to-border districts in the west, as well as in a band throughout the middle of Germany, in rather low population density areas. Regional variation in the prevalence range from 19 to 53 % between districts. Regional deprivation can explain part of this variation.

Conclusions

Including area deprivation measures helped identify an influence of especially regional income and occupational deprivation on antibiotic prescriptions for children. Regional analysis such as this can help identify specific regions and groups of persons to address information programs on the risks of preventable antibiotic consumption and alternative treatment methods.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

Notes

  1. http://www.who.int/world-health-day/2011/en/.

  2. It is based on 439 districts in Germany in 2008. Those districts were reclassified into the 412 districts present in Germany in 2010 after area reforms in some federal states.

  3. http://www.bkg.bund.de/nn_149594/EN/News/01News/N2010/2010__Product_20Update-VG2500.html__nnn=true.

References

  1. Nyquist AC, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA. 1998;279:875–7.

    Article  PubMed  CAS  Google Scholar 

  2. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278:901–4.

    Article  PubMed  CAS  Google Scholar 

  3. File TM Jr, Hadley JA. Rational use of antibiotics to treat respiratory tract infections. Am J Manag Care. 2002;8:713–27.

    PubMed  Google Scholar 

  4. McCaig LF, Besser RE, Hughes JM. Antimicrobial drug prescription in ambulatory care settings, United States, 1992–2000. Emerg Infect Dis. 2003;9:432–7.

    Article  PubMed  Google Scholar 

  5. Ong DSY, Kuyvenhoven MM, van Dijk L, Verheij TJM. Antibiotics for respiratory, ear and urinary tract disorders and consistency among GPs. J Antimicrob Chemother. 2008;62:587–92.

    Article  PubMed  CAS  Google Scholar 

  6. Nadeem Ahmed M, Muyot MM, Begum S, Smith P, Little C, Windemuller FJ. Antibiotic prescription pattern for viral respiratory illness in emergency room and ambulatory care settings. Clin Pediatr (Phila). 2010;49:542–7.

    Article  CAS  Google Scholar 

  7. Moro ML, Marchi M, Gagliotti C, Di Mario S, Resi D; “Progetto Bambini a Antibiotici [ProBA]” Regional Group. Why do paediatricians prescribe antibiotics? Results of an Italian regional project. BMC Pediatr. 2009;9:69.

    Article  PubMed  Google Scholar 

  8. Lieberthal AS. Acute otitis media guidelines: review and update. Curr Allergy Asthma Rep. 2006;6:334–41.

    Article  PubMed  Google Scholar 

  9. Koneczny N, Schmidt-Troschke S, Berger T, Isfort J, Floer B, Vollmar HC, et al. Akute otitis media (AOM) bei kindern (ICD: H66.0): eine evidenzbasierte Leitlinie. Klin Pädiatr. 2004;216:215–24.

    Article  PubMed  CAS  Google Scholar 

  10. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004;113:1451–65.

    Article  Google Scholar 

  11. Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of childhood otitis media in primary care. A national clinical guideline. 2003. http://www.sign.ac.uk

  12. National Guideline Clearinghouse (NGC). Evidence based clinical practice guideline for medical management of acute otitis media in children 2 months to 13 years of age. 2006. http://www.guideline.gov

  13. University of Michigan Health System (UMHS). Guidelines for clinical care otitis media key points. 2002. http://cme.med.umich.edu/pdf/guideline/om.pdf

  14. Rosenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2006;134:S4–23.

    Article  PubMed  Google Scholar 

  15. Goossens H, Ferech M, Vander Stichele R, Elseviers M; ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365:579–87.

    PubMed  Google Scholar 

  16. Cars O, Mölstad S, Melander A. Variation in antibiotic use in the European Union. Lancet. 2001;357:1851–3.

    Article  PubMed  CAS  Google Scholar 

  17. Pastor García E, Eiros Bouza JM, Mayo Iscar A, Bachiller R. Influence of population structure on the consumption of systemic antibiotics. Int J Antimicrob Agents. 2005;25:84–8.

    Article  PubMed  Google Scholar 

  18. Bruinsma N, Filius PM, De Smet PA, Degener J, Endtz P, van den Bogaard AE, Stobberingh EE. Antibiotic usage and resistance in different regions of the Dutch community. Microb Drug Resist (Larchmont, N.Y.). 2002;8:209–14.

    Article  CAS  Google Scholar 

  19. Filippini M, Masiero G, Moschetti K. Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland. Health Policy (Amsterdam, Netherlands). 2006;78:77–92.

    Article  Google Scholar 

  20. Kern WV, de With K, Nink K, Steib-Bauert M, Schröder H. Regional variation in outpatient antibiotic prescribing in Germany. Infection. 2006;34:269–73.

    Article  PubMed  CAS  Google Scholar 

  21. Pichichero ME. Understanding antibiotic overuse for respiratory tract infections in children. Pediatrics. 1999;104:1384–8.

    Article  PubMed  CAS  Google Scholar 

  22. Thrane N, Olesen C, Schønheyder HC, Sørensen HT. Socioeconomic factors and prescription of antibiotics in 0- to 2-year-old Danish children. J Antimicrob Chemother. 2003;51:683–9.

    Article  PubMed  CAS  Google Scholar 

  23. Mangrio E, Wremp A, Moghaddassi M, Merlo J, Bramhagen A-C, Rosvall M. Antibiotic use among 8-month-old children in Malmö, Sweden—in relation to child characteristics and parental sociodemographic, psychosocial and lifestyle factors. BMC Pediatr. 2009;9:31.

    Article  PubMed  Google Scholar 

  24. Kondo N, Sembajwe G, Kawachi I, van Dam RM, Subramanian SV, Yamagata Z. Income inequality, mortality, and self rated health: meta-analysis of multilevel studies. BMJ. 2009;339:b4471.

    Article  PubMed  Google Scholar 

  25. Kawachi I, Subramanian SV, Almeida-Filho N. A glossary for health inequalities. J Epidemiol Community Health. 2002;56:647–52.

    Article  PubMed  CAS  Google Scholar 

  26. Noble M, Wright G, Smith G, Dibben C. Measuring multiple deprivation at the small-area level. Environ Plan A. 2006;38:169–85.

    Article  Google Scholar 

  27. Maier W, Fairburn J, Mielck A. Regionale deprivation und mortalität in Bayern. Entwicklung eines “Index Multipler Deprivation” auf Gemeindeebene. Gesundheitswesen. 2012;74:416–425.

    Google Scholar 

  28. Kuznetsov L, Maier W, Hunger M, Meyer M, Mielck A. Associations between regional socioeconomic deprivation and cancer risk: analysis of population-based Cancer Registry data from Bavaria, Germany. Prev Med. 2011;53:328–30.

    Article  PubMed  Google Scholar 

  29. Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P, et al. A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health. 2006;60:290–7.

    Article  PubMed  Google Scholar 

  30. Larsen K, Merlo J. Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol. 2005;161:81–8.

    Article  PubMed  Google Scholar 

  31. Piovani D, Clavenna A, Cartabia M, Bonati M; Antibiotic Collaborative Group. The regional profile of antibiotic prescriptions in Italian outpatient children. Eur J Clin Pharmacol. 2012;68:997–1005.

    Article  PubMed  Google Scholar 

  32. Franchi C, Sequi M, Bonati M, Nobili A, Pasina L, Bortolotti A, et al. Differences in outpatient antibiotic prescription in Italy’s Lombardy region. Infection. 2011;39:299–308.

    Article  PubMed  CAS  Google Scholar 

  33. Hoffmann F, Icks A. Diabetes “epidemic” in Germany? A critical look at health insurance data sources. Exp Clin Endocrinol Diabetes. 2012;120:410–5.

    Article  PubMed  CAS  Google Scholar 

  34. Hoffmann F, Icks A. Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann Health-Care Monitor. Gesundheitswesen. 2012;74:291–7.

    Article  PubMed  CAS  Google Scholar 

  35. Abbas S, Ihle P, Heymans L, Küpper-Nybelen J, Schubert I. Differences in antibiotic prescribing between general practitioners and pediatricians in Hesse, Germany. Dtsch Med Wochenschr (1946). 2010;135:1792–7.

    Article  CAS  Google Scholar 

Download references

Acknowledgments

This study is based on a preliminary study commissioned and sponsored by the Bertelsmann Stiftung for the project “Faktencheck Gesundheit”. We thank the BARMER GEK for the provision of the data.

Conflict of interest

The authors declare that they have no conflict of interests.

Author information

Authors and Affiliations

  1. Centre for Social Policy Research, University of Bremen, UNICOM-Gebäude, Mary-Somerville-Str. 5, 28359, Bremen, Germany

    D. Koller, F. Hoffmann, K. Tholen, R. Windt & G. Glaeske

  2. Institute of Health Economics and Health Care Management, Helmholtz German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany

    W. Maier

Authors
  1. D. Koller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Maier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Tholen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Windt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Glaeske
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Koller.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Koller, D., Hoffmann, F., Maier, W. et al. Variation in antibiotic prescriptions: is area deprivation an explanation? Analysis of 1.2 million children in Germany. Infection 41, 121–127 (2013). https://doi.org/10.1007/s15010-012-0302-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-012-0302-1

Keywords

search

Navigation