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Systemic antibiotic use among children and adolescents in Germany: a population-based study

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Abstract

The aim of the study was to comprehensively describe antibiotic use among children and young adolescents in Germany. Outpatient prescriptions of systemic antibiotics to children (<15 years) were analysed using data from four German statutory health insurances for the years 2004 to 2006. Annual prevalence of antibiotic prescriptions was determined using the average number of insured children during the respective year as reference population. Annual antibiotic prescription rates were calculated per 1,000 person years. Both figures were stratified by age (0–4, 5–9 and 10–14 years) and sex. Frequent indications for prescribing were analysed. Annual prevalence of antibiotic prescriptions rose from 35.68 % [95 % confidence intervals (CI), 35.62–35.75] in 2004 to 37.79 % [95 % CI, 37.72–37.86] in 2006. Prescription rates slightly increased by 6.01 % from 668.54 [95 % CI, 667.34–669.72] antibiotic prescriptions per 1,000 person years in 2004 to 708.71 [95 % CI, 707.47–709.95] in 2006. In 2006, prescriptions of broad-spectrum penicillins (25.09 %), second-generation cephalosporins (18.11 %) and narrow-spectrum penicillins (16.45 %) were most frequent. The most common indication for antibiotic prescribing was tonsillitis followed by bronchitis, otitis media, acute upper respiratory infections and scarlet fever. Conclusion: In contrast to other northern European countries, paediatric prescription rates are high in Germany. This and the frequent prescribing of broad spectrum agents for the treatment of mostly viral self-limiting conditions indicate limited adherence to evidence-based practice guidelines in antibiotic prescribing in the German outpatient setting.

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Acknowledgments

We wish to thank Denise Heuer for helping with data extraction and analysis. The authors are grateful to all SHIs that provided data for this study. Those are the Allgemeine Ortskrankenkasse (AOK) Bremen/Bremerhaven, the Deutsche Angestellten-Krankenkasse (DAK), the Handelskrankenkasse (HKK) and the Techniker Krankenkasse (TK). The study did not receive financial support.

Conflict of interest

EG is running a department that occasionally performs studies for pharmaceutical industries with the full freedom to publish. The companies include Mundipharma, Bayer-Schering, Stada, Sanofi-Aventis, Sanofi-Pasteur, Novartis, Celgene and GSK. EG has been consultant to Bayer-Schering, Nycomed, Teva and Novartis in the past. All these projects are unrelated to this project. JH does not report any conflict of interest.

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Correspondence to Edeltraut Garbe.

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Interim findings of this study have been published as an abstract at the 26th Conference on Pharmacoepidemiology and Therapeutic Risk Management (ICPE).

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Holstiege, J., Garbe, E. Systemic antibiotic use among children and adolescents in Germany: a population-based study. Eur J Pediatr 172, 787–795 (2013). https://doi.org/10.1007/s00431-013-1958-y

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