Using Prescription Patterns in Primary Care to Derive New Quality Indicators for Childhood Community Antibiotic Prescribing

BACKGROUND: To describe patterns of antibiotic outpatient use in three European countries, including two new pediatric-specific quality indicators (QIs). METHODS: A cohort study was conducted, 2001-2010, using electronic primary care records of 2,196,312 children up to 14 (Pedianet, Italy) or 18 years (THIN, UK; IPCI, the Netherlands) contributing 12,079,620 person-years. Prevalence rates of antibiotic prescribing per year were calculated and antibiotics accounting (drug utilization) for 90% of all antibiotic prescriptions were identified (DU90% method). The ratio between users of broad to narrow-spectrum penicillins, cephalosporins and macrolides (B/N ratio) and two pediatric-specific quality indicators (QIs): the proportion of amoxicillin users (amoxicillin index, AI) and the ratio between users of amoxicillin to broad-spectrum penicillins, cephalosporins and macrolides (A/B ratio) were determined. RESULTS: The overall annual prevalence of antibiotic prescriptions was 18.0% in the Netherlands, 36.2% in the UK and 52.0% in Italy. Use was maximal in the first years of life. The number of antibiotics accounting for the DU90% was comparable. The B/N ratio varied widely from 0.3 to 74.7. The AI was highest in the Netherlands and the UK (50-60%), lowest in Italy (30%) and worsened over time in the UK and Italy. The A/B ratio in 2010 was 0.3 in Italy, 1.7 in the Netherlands and 5.4 in the UK. CONCLUSIONS: The patterns of antibiotic prescribing varied highly with age and country. The pediatric-specific QIs combined with the total prevalence rate of use provide a clear picture of the trends of community childhood antibiotic prescribing, allowing monitoring of the impact of policy interventions.