Article Text

Download PDFPDF

Original article
Assessing the quality of paediatric antibiotic prescribing by community paediatricians: a database analysis of prescribing in Lombardy
  1. Daniele Piovani1,
  2. Antonio Clavenna1,
  3. Massimo Cartabia1,
  4. Angela Bortolotti2,
  5. Ida Fortino2,
  6. Luca Merlino2,
  7. Maurizio Bonati1
  1. 1 Department of Public Health, Laboratory for Mother and Child Health, IRCCS – Istituto di Ricerche farmacologiche "Mario Negri", Milan, Italy
  2. 2 Regional Health Ministry, Lombardy Region, Milan, Italy
  1. Correspondence to Dr Daniele Piovani; daniele.piovani{at}


Objective To evaluate the quality of paediatricians’ antibiotic prescribing using administrative databases.

Methods The data source was the database of reimbursed prescriptions of the Lombardy Region, Italy. Children 1–13 years were included. An index prescription was defined as the first antibiotic prescription during a year period (2011) that occurred without previous, recent, antibiotic prescriptions or hospital or emergency department admissions. The A indicator was the percentage of children, cared for by paediatricians, receiving amoxicillin at the index prescription (minimum target 50%). The B indicator was the percentage of children receiving exclusively non-penicillin antibiotics in unrelated infection episodes (maximum target 10%). Indicators were evaluated for each prescriber and geographical area.

Results Overall 424 280 children (cared for by 1164 paediatricians) received an index prescription and were included in the study. Amoxicillin alone was prescribed at the index prescription only to 23.6% of children (7.9%–46.3% within different areas of the region).

The percentage of paediatricians who reached the target for the quality indicators was low (12.8% A indicator; 54.0% B indicator; 11.3% both). Almost half of the paediatricians (44.5%) showed inadequate quality of antibiotic prescribing, failing to reach the target for both indicators. Quality of prescribing was about four times worse in high prescribers and younger paediatricians. A geographical cluster of paediatricians reaching the target for both indicators was identified. These paediatricians had, for several years, previously been involved in educational programme.

Conclusions Quality of prescribing was generally unsatisfactory, but increased in a group of paediatricians previously involved in educational interventions and increased with increasing age. Further studies are warranted in order to validate these promising indicators as a benchmarking tool in other studies, when diagnosis is unknown.

  • child
  • paediatricians
  • quality of health care
  • anti-bacterial agents
  • pharmacoepidemiology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors All the authors contributed equally to the design of the study. DP collected the data and wrote the first draft of the manuscript. MC undertook the statistical analysis. AC contributed in planning the data analysis and in writing the manuscript. AC, AB, IF, LM and MB supervised the study. All authors contributed to and have approved the final manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.