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Increasing paediatric prescribing rates in British Columbian children: cause for concern?

Abstract

Objectives

Antibiotic prescribing in paediatric care is highly prevalent, and quite often, children are prescribed for conditions, like upper respiratory tract infections, which are self-limiting and viral in aetiology. The purpose of this study was to identify potential new targets for provincial antimicrobial stewardship efforts.

Methods

Antibiotic prescription data for children were extracted from a provincial prescription database, linked to physician billing data in order to obtain diagnostic information, and then combined with demographic data in order to obtain patient age, sex and geographic location. Prescription rates were calculated, and trends were examined by major anatomical therapeutic chemical (ATC) classification.

Results

Our cohort included an average of 271,134 children per year and 1,767,652 antibiotic prescriptions. Antibiotic utilization increased 4.5% (from 453 to 474 prescriptions per 1000 population). The greatest increases in prescribing were seen in children aged 0–2 years. Increased indication-specific rates of prescribing were observed in children aged 0–2 years, across every category. Although antibiotic use for upper respiratory tract infections decreased, prescribing rates remain as high as 5 times more than other indications.

Conclusion

Past studies have widely illustrated decreasing or static rates of prescribing in British Columbia. However, these results signal a potential problem in the sphere of paediatric antibiotic prescribing, wherein rates have been increasing since 2013. Despite the success of provincial efforts in reducing the use of broad-spectrum penicillins, marked surges in the use of classes like tetracyclines, quinolones and other antibacterials identify a new potential target for provincial stewardship.

Résumé

Objectifs

La prescription d’antibiotiques en pédiatrie est hautement prévalente, et très souvent, les enfants se les font prescrire pour des affections spontanément résolutives et à étiologie virale, comme les infections des voies respiratoires supérieures. Notre objectif était de trouver de nouvelles cibles possibles pour les démarches provinciales d’intendance des antimicrobiens.

Méthode

Les données sur la prescription d’antibiotiques aux enfants ont été extraites d’une base de données provinciale sur les ordonnances, que nous avons jumelées aux données de facturation des médecins pour obtenir des informations sur le diagnostic, puis combinées avec les données démographiques pour obtenir l’âge, le sexe et le lieu géographique des patients. Les taux de prescription ont été calculés, et les tendances ont été examinées par grande catégorie du Système de classification anatomique thérapeutique et chimique (ATC).

Résultats

Notre cohorte comptait en moyenne 271 134 enfants par année et 1 767 652 ordonnances d’antibiotiques. Le recours aux antibiotiques a augmenté de 4,5 % (de 453 à 474 ordonnances p. 1000 habitants). La plus forte hausse a été observée chez les enfants de 0 à 2 ans. Des taux accrus de prescription pour indication précise ont été observés chez les enfants de 0 à 2 ans, dans toutes les catégories. Bien que le recours aux antibiotiques pour les infections des voies respiratoires supérieures ait diminué, les taux de prescription sont encore 5 fois supérieurs aux taux de prescription pour les autres indications.

Conclusion

Les études passées font généralement état de taux de prescription stables ou décroissants en Colombie-Britannique. Il semble par contre y avoir un problème possible dans la prescription d’antibiotiques en pédiatrie, où les taux augmentent depuis 2013. Malgré l’efficacité des démarches provinciales pour réduire l’utilisation des pénicillines à spectre étendu, les augmentations marquées de l’utilisation des catégories comme les tétracyclines, les quinolones et autres antibactériens représentent une nouvelle cible possible pour l’intendance provinciale.

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Correspondence to Fawziah Marra.

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Saatchi, A., Marra, F. Increasing paediatric prescribing rates in British Columbian children: cause for concern?. Can J Public Health 111, 523–530 (2020). https://doi.org/10.17269/s41997-020-00298-2

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Keywords

  • Antibiotics
  • Paediatrics
  • Antimicrobial stewardship
  • Resistance

Mots-clés

  • Antibiotiques
  • Pédiatrie
  • Gestion responsable des antimicrobiens
  • Résistance