Cross‐national comparison of paediatric antibiotic use in Norway, Portugal and Hungary

Abstract

A cross‐national comparison was performed on paediatric (0‐19 years) antibiotic use in Hungary, Norway and Portugal to explore and compare the scale and pattern of paediatric antibiotic use in these three European countries. Ambulatory care systemic antibiotic use (ATC: J01) was retrieved from national databases for year 2014. The main outcome measure was number of antibacterial packages per child inhabitant per year (packages/child/year) and was further stratified by age groups. Paediatric antibiotic use peaked in Hungary with 1.3 packages/child/year, followed by Portugal (0.8) and Norway (0.3). This ranking was retained and was most prominent in the 5‐ to 9‐year and 10‐ to 14‐year age groups. The pattern of antibiotic use in different paediatric age groups varied also substantially between countries. Narrow‐spectrum penicillins were much commonly used in Norway in all paediatric age subgroups in comparison with Hungary and Portugal. Newer, broad‐spectrum cephalosporins and macrolides were widely prescribed for Hungarian and Portuguese children in all paediatric subgroups in contrast to Norway, while tetracyclines were commonly prescribed for Norwegian adolescents. The scale and pattern of paediatric antibiotic use in Hungary and Portugal were very different compared with Norway. The high antibiotic exposure and the high consumption of broad‐spectrum penicillins begin in childhood in Hungary and Portugal which underpins the responsibility of paediatric GPs.

Antibacterial use by birth year and birth season in children 0-2 years in Norway

“…A more recent study from Hungary, Norway and Portugal identified antibacterial use as packages/child/ year in 2014 with children age 0-19, stratified by age groups. This study identifies the youngest children (0-4 years) as the most frequent users of antibacterials, with respectively 2.2, 0.4 and 1.0 packages/child/year in Hungary, Norway and Portugal (29). The results from Norway are on par with our results, even though we are using different age stratification and proxy-measure for antibacterial use.…”

Antibiotic prescriptions for children younger than 5 years with acute upper respiratory infections in China: a retrospective nationwide claims database study

“…On the contrary, a cross-national analysis on antibiotic use in children of 6 countries found that [40], in the United States, South Korea, Italy, Spain, and Norway, penicillins were the most common prescribed antibiotics. In US and Norway [40,41], if a penicillin was prescribed for pediatrics, the narrow-spectrum penicillins were commonly used. According to the Chinese Pharmacopeia Guidelines for Clinical Drug Use, penicillins require skin tests before use in China, which largely limits the use of penicillins in our country.…”

Marked reductions in outpatient antibiotic prescriptions for children and adolescents – a population-based study covering 83% of the paediatric population, Germany, 2010 to 2018

“…The observed prescription rate in German children (0–14 years) of 428 prescriptions per 1,000 persons in 2018 was considerably lower than in Italian children in 2016 (881/1,000 [ 33 ]) and lower than the package rates from Hungary (1,386/1,000) and Portugal (838/1,000) in 2014, but more than 70% higher than package rates from Norway (236/1,000 in 2014) [ 18 ] and the Netherlands (247/1,000 in 2016) [ 17 ]. Of note, the package rates for Hungary, Portugal and Norway reported here for the age group 0–14 years were calculated based on the age-specific numerator and denominator data that can be found in Benko et al [ 18 ], who included the age group 0–19 years in their study. The strong variations among European countries are unlikely to reflect an actual therapeutic need originating in marked inter-country differences in the burden of infectious diseases.…”

“…In contrast, use of cephalosporins in children and the total population is negligible in Scandinavian countries, the Netherlands and the United Kingdom [ 6 , 17 , 18 , 37 ]. While German clinical practice guidelines for the outpatient treatment of acute respiratory infections commonly recommend cephalosporins as second- or third-line treatment [ 8 , 26 ], these antibiotics are not mentioned as treatment option by Dutch guidelines [ 17 ].…”

“…Such comparisons are only conducted sporadically, i.e. in single studies mostly comparing two countries [5,[16][17][18] and a cohort study comprising five European countries [6]. Despite the low use of antibiotics in the total German population, prescription rates in German children were markedly higher in that cohort study compared with their Danish, British and Dutch peers in 2008 [6].…”