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Monitoring of antibiotic prescription and consumption behavior is crucial. The Access, Watch and Reserve (AWaRe) classification of antibiotics has been recently introduced in order to measure and improve patterns of antibiotic use. In this study, retrospective data about systemic antibiotic consumption (expressed in defined daily dose per 1000 inhabitants per day [DID]) in pediatric outpatients in a region in Northern Spain (around 100000 children up to 14 years old) from 2005 to 2018 were analysed and compared with antibiotic consumption in general population in Spain. The pattern of use was analysed by the percentage of the current AWaRe categories, the Access-to-Watch index and the amoxicillin index. Data were calculated annually and compared into two periods. Mean antibiotic consumption in pediatric outpatients was 14.0 DID (CI 95% 13.38–14.62). It remained stable throughout the study and was lower than consumption in general population in Spain, particularly from 2016. Changes in the consumption of the main active principles have led to an improvement in the three metrics of the pattern of use. It is important to have a thorough knowledge of the methodology applied in studies about antibiotic consumption. There is a lack of an optimal standardized metric for pediatric population.