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

Abstract

Background Prescribing of systemic antibiotics in general and of cephalosporins in particular in German paediatric outpatients has previously been reported to be higher than in other European countries. Aim Our objective was to assess recent trends in antibiotic prescribing in German children. Methods This study was conducted as consecutive annual cross-sectional analyses and included all children aged 0–14 years (n = 9,389,183 in 2018) covered by statutory health insurance in Germany. Annual antibiotic prescription rates from 2010 to 2018 were calculated for the age groups 0–1, 2–5, 6–9 and 10–14 years. Poisson regression was used to estimate trends of prescription rates by age group and antibiotic subgroup. Results Overall, the age-standardised antibiotic prescription rate decreased significantly by 43% from 746 prescriptions per 1,000 persons in 2010 to 428 per 1,000 in 2018 (p < 0.001). Reductions were most pronounced in the age groups 0–1 year (−50%) and 2–5 years (−44%). The age group 2–5 years exhibited the highest prescription rate with 683 per 1,000 in 2018 (0–1 year: 320/1,000; 6–9 years: 417/1,000; 10–14 years: 273/1,000). Cephalosporins (second and third generation) accounted for 32% of prescribed antibiotics. Conclusions Marked reductions in antibiotic prescribing during the last decade indicate a change towards more judicious paediatric prescribing habits. Compared with other European countries, however, prescribing of second- and third-generation cephalosporins remains high in Germany, suggesting frequent first-line use of these substances for common respiratory infections. Considerable regional variations underline the need for regionally targeted interventions.

Quality Appraisal of Ambulatory Oral Cephalosporin and Fluoroquinolone Use in the 16 German Federal States from 2014–2019

“…Encouragingly, the trend analysis of oral cephalosporin DID during 2014-2019 showed a significant reduction in all federal states. This is in line with the observation of Holstiege et al that the use of cephalosporins has declined in Germany during the period 2010-2018, predominantly due to a reduction in ambulatory prescriptions for pediatric patients and, potentially, the introduction of pneumococcal vaccination for children in 2006 [14,35]. In the 2019 guideline on antibiotic therapy for ENT infections, the use of cefuroxime was restricted compared to the 2008 guideline.…”

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

“…Particularly, the determinant to receive feedback from colleagues is mirrored in our data. Since antibiotic prescribing rates have been decreasing in German primary care in recent years [ 3 , 25 , 26 , 27 , 28 ] and the observed participant prescribing rates for acute non-complicated infections were moderate prior to the ARena project [ 29 ], outcome analyses based on the claims data will inform about the extent of effects that were possible to be achieved by ARena, particularly regarding the guideline-conform use of recommended antibiotics.…”

Rückgang der ambulanten Antibiotikaverordnungen bei Kindern und Jugendlichen in Deutschland 2010–2019. Regionale Entwicklung in den deutschen KV-Regionen

“…In den letzten 10 Jahren ist das Thema Antibiotic Stewardship (ABS) auch in der ambulanten Kinder-und Jugendmedizin immer stärker in den Vordergrund gerückt [1-3], insbesondere, weil ein nichtleitlinienkonformer Einsatz von Antibiotika zunehmend kritisch betrachtet wird [4] und das Verordnungsverhalten der niederge-lassenen Ärzte 1 aufgrund des großen Verordnungsvolumens einen Selektionsdruck auf multiresistente Erreger ausübt [5,6]. Der Fachbereich V Epidemiologie und Versorgungsatlas des Zentralinstituts (Zi) für die kassenärztliche Versorgung in der Bundesrepublik Deutschland hat in den letzten Jahren wiederholt bundesweite und krankenkassenübergreifende Antibiotikaverordnungsdaten nach § 300 SGB V publiziert, in denen auch Ergebnisse von 0-bis 14-Jährigen enthalten sind [7][8][9]. In der hier vorgelegten Analyse wurden diese Daten um Ergebnisse aus detaillierten Analysen zur altersgruppenspezifischen Verteilung von Wirkstoffgruppen sowie altersgruppen-und wirkstoffgruppenspezifischen regionalen Entwicklungen in der ambulanten pädiatrischen Versorgung bis einschließlich des Jahres 2019 erweitert.…”

“…Die deutlichen regionalen Unterschiede im Verordnungsverhalten lassen sich nach vernunftbezogenem Ermessen innerhalb Deutschlands nicht plausibel durch Unterschiede im Erkrankungs-oder Patientenspektrum erklären [7,8]. Ansatzpunkte für Erklärungsversuche könnten sein, dass sich regionale "Schulen" etabliert haben und sich Verordnungsverhalten von Ärzten gegenseitig beeinflusst, im Sinne einer positiven Rückkopplung "ansteckend" ist und so über Erfahrungen und Erwartungen auf Arzt-wie auch Patientenseite zu regionalen "Verordnungskulturen" führt.…”