Prevalence of Antibiotic Use for Pediatric Acute Upper Respiratory Tract Infections in Korea

Abstract

This study was conducted to estimate the prevalence of antimicrobial prescribing for acute upper respiratory tract infections (URI) among pediatric outpatients and to identify the national patterns of its use from 2009 to 2011 in Korea. Using National Patients Sample database from 2009 to 2011, we estimated the frequency of antibiotics prescribing for URI in pediatric outpatients with diagnoses of acute nasopharyngitis (common cold), acute sinusitis, acute pharyngitis, acute tonsillitis, acute laryngitis/tracheitis, acute obstructive laryngitis/epiglottitis, and acute upper respiratory infections of multiple and unspecified sites. The proportions of each antibiotic class were calculated by year and absolute and relative differences were estimated. Also, we investigated daily amount of prescribed antibiotics per defined population according to the type of medical care institution, physician specialty, and geographic region. The overall antibiotic prescribing proportion was 58.7% and its annual proportion slightly decreased (55.4% in 2011 vs. 60.5% in 2009; adjusted odds ratio, 0.82; 95% confidence interval, 0.82-0.83). Variations by the type of medical care institution were observed. Tertiary hospitals (45.0%) were less likely to prescribe antibiotics than primary care clinics (59.4%), hospitals (59.0%), and general hospitals (61.2%); they showed different tendencies in choosing antibiotics. Variations by physician specialty and region were also observed. Prevalence of antimicrobial prescribing for pediatric URI is still considered higher than that of western countries and varies by the type of medical care institution, physician specialty, and geographic region.Graphical Abstract

A national pharmacoepidemiological study of antibiotic use in Korean paediatric outpatients

“…HIRA is an independent and public insurance agency responsible for reviewing medical fees, evaluating whether the prescribed drugs are medically necessary usually based on the indications and dosages on labels, and ultimately providing national insurance coverage for more than 95% of Korean citizens 12. The study subjects were patients younger than 18 years old who visited ambulatory care facilities from 1 January to 31 December 2011 and were prescribed systemic antimicrobial agents (oral route or injection) at least once based on drug category 610 (antibacterial agents) and 620 (chemotherapeutic agents such as sulphonamides) as listed in the Korean regulations 15.…”

“…Koreans consumed 36% more antibiotics than the Organization for Economic Cooperation and Development (OECD) average in 2011 9 11. Patterns of antibiotic use in Korean paediatrics were reported recently using sample data collected from only 10% of the patients 12 13. However, evaluation of broad-spectrum antibiotic use and analysis of acute bronchitis, a valid quality indicator in the primary care setting, was not included 14.…”

The impact analysis of a multiplex PCR respiratory panel for hospitalized pediatric respiratory infections in Japan

“…While children with respiratory tract infections caused by bacterial pathogens may benefit from antimicrobials, antimicrobial use for viral respiratory infection is not indicated and has led to the subsequent emergence of antimicrobial-resistant microorganisms [4e7]. Although viral infections account for the majority of pediatric respiratory infections, antimicrobials are often prescribed for these cases [8,9]. Previous surveys pointed out that the overprescription of oral cephalosporins and macrolides, which are usually prescribed for pediatric respiratory tract infections, is a serious issue in Japan [10,11].…”

International Coherence of Pediatric Drug Labeling for Drug Safety: Comparison of Approved Labels in Korea and the United States

“…HIRA is an independent and public insurance agency responsible for reviewing medical fees and evaluating whether prescribed drugs are medically necessary based on indications and dosages in labels. It provides national insurance coverage for more than 95% of Korean citizens . We obtained HIRA‐PPS data submitted from January to December 2013.…”

“…The labeling information was also analyzed according to three age groups as follows: early childhood (2–5 years), middle childhood (6–11 years), and adolescence (12–18 years). Infants and toddlers younger than 24 months old were excluded from the analysis due to uncertainty in the sample data …”