Antibiotic Prescribing Patterns in Paediatric Primary Care in Italy: Findings from 2012–2018

Abstract

Comprehensive data are needed to monitor antibiotic prescribing and inform stewardship. We aimed to evaluate the current antibiotic prescribing patterns, including treatment switching and prolongation, in the paediatric primary care setting in Italy. This database study assessed antibiotic prescriptions retrieved from Pedianet, a paediatric primary care database, from 1 January 2012 to 31 December 2018. Descriptive analyses were stratified by diagnosis class, calendar year, and children’s age. Generalized linear Poisson regression was used to assess variation in the prescriptions. In total, 505,927 antibiotic prescriptions were included. From 2012 to 2018, the number of antibiotics per child decreased significantly by 4% yearly from 0.79 in 2012 to 0.62 in 2018. Amoxicillin prescriptions decreased with increasing children’s age, while macrolides and third-generation cephalosporins had the opposite trend. Prescriptions were associated with a diagnosis of upper respiratory infection in 23% of cases, followed by pharyngitis (21%), bronchitis and bronchiolitis (12%), and acute otitis media (12%). Eight percent of treatment episodes were prolonged or switched class, mostly represented by co-amoxiclav, macrolides, and third-generation cephalosporins. Our findings report an overall decrease in antibiotic prescriptions, but pre-schoolers are still receiving more than one antibiotic yearly, and broad-spectrum antibiotics prescription rates remain the highest.

Antibiotic Prescription Patterns in the Paediatric Primary Care Setting before and after the COVID-19 Pandemic in Italy: An Analysis Using the AWaRe Metrics

“…In our study, the ratio of Watch on Access prescriptions, as well as the ratio of amoxicillin on co-amoxiclav, did not change after the containment measures implementation, as would be expected, assuming that the overall incidence of severe or non-responding to first-line treatment infections is dramatically decreased [26]. As previously noted in other studies, broad-spectrum antibiotics remain widely prescribed in primary care in Italy, and from the current study, it is evident that this did not improve after the COVID-19 pandemic [27].…”

“…The Pedianet database contains patient-level data from children followed by around 160 FPs distributed throughout several Italian regions, including Friuli-Venezia Giulia, Liguria, Lombardia, Piemonte, Veneto, Lazio, Marche, Toscana, Abruzzo, Campania, Sardegna, and Sicilia. The Pedianet database has been widely used since 2004 to conduct pharmacoepidemiological and pharmacovigilance studies [27]. According to the Italian NHS, each child is assigned to a FP who is the primary referral for health-related matters.…”

“…Diagnoses were retrieved using ICD9-CM codes and classified as follows in line with previously published studies [27] and confirmed by paediatricians specialised in infectious diseases (C.L., D.D): lower respiratory tract infections (LRTI), upper respiratory class infections (URTI), urinary tract infections (UTI), skin and soft tissue infection (SSTI), and not available (NA) (Table S5). Free text algorithms were used to explore reason for prescriptions not associated with an ICD9-CM code.…”

Watchful Waiting in Pediatric Acute Otitis Media: A Real Practice Approach or an Intangible Desideratum?

“…The highest rate of amoxicillin use in an analysis of the antibiotic prescription patterns in children aged 2 years or older was 81.2% [ 19 ]. Amoxicillin/clavulanic acid was the preferred antibiotic agent in the two studies reporting AOM cases from Italy: Palma et al [ 18 ] described a 51% rate of amoxicillin/clavulanic acid use, whereas Barbieri et al [ 15 ] described a rate of 36%. Denmark was the only country reporting penicillin V as a first-choice regimen for children with AOM [ 22 ].…”

“…Cephalosporins were the third most used antibiotic for AOM after amoxicillin and amoxicillin/clavulanic acid in five out of twelve studies. Specific antibiotics belonging to the first three generations of cephalosporins were preferred in studies from Australia (cephalexin) [ 21 ], Spain (cefuroxime) [ 20 ], France and Italy (cefpodoxime proxetil) [ 15 , 17 , 18 ], and the United States (cefdinir) [ 19 ]. Seven out of twelve papers reported the use of macrolides in a small proportion of cases, ranging from 1.3% to 10%.…”