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Original research
Antibiotic prescription in the outpatient paediatric population attending emergency departments in Lombardy, Italy: a retrospective database review
  1. Francesco Messina1,
  2. Antonio Clavenna1,
  3. Massimo Cartabia1,
  4. Daniele Piovani1,
  5. Angela Bortolotti2,
  6. Ida Fortino2,
  7. Luca Merlino2,
  8. Maurizio Bonati1
  1. 1 Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
  2. 2 Regional Health Ministry, Lombardy Region, Milan, Italy
  1. Correspondence to Dr Antonio Clavenna; antonio.clavenna{at}


Objectives This study aimed to assess the appropriateness of antibiotic prescription in children seen in emergency departments (EDs) and to compare prescription profiles in ED and primary care.

Design This is a retrospective analysis of healthcare administrative databases.

Setting The study analysed data collected in emergency departments (EDs) and primary care practices (PCPs) in Lombardy, Italy.

Participants Children and adolescents between 1 and 13 years old with an ED access and/or an antibiotic prescription in the first semester of 2012 participated in the study. Only those with an index event (ie, without ED access, hospital admissions or antibiotic prescriptions in the previous 60 days) were included.

Main outcome measures The main outcomes are percentage of subjects receiving amoxicillin (first-choice antibiotic) and percentages receiving macrolides/cephalosporins (second-choice therapies).

Results During the observation period, 133 275 children had one ED access, and 26 087 (19.6%) received an antibiotic prescription. In all, 56.1% of children seen for upper respiratory tract infections (URTIs) received an antibiotic, with a prevalence of 67.8% for otitis media and 56.4% for pharyngotonsillitis; 22.3% of children were given amoxicillin after a visit for URTIs, with no differences among infections, and 19.6% received macrolides and cephalosporins. Few differences were found when comparing the index antibiotic prescriptions in ED and PCP settings. A higher prescription of second-choice antibiotics was observed among children cared for by PCPs compared with children attending EDs (31.3% vs 23.4%, χ2 M-H=720, p<0.001). The place of residence was the main determinant of the qualitative profile of prescriptions.

Conclusions More must be done to improve rational use of antibiotics in the ED and PCP setting, and educational interventions including physicians in both setting are strongly needed.

  • accident & emergency
  • epidemiology
  • pharmacology
  • health services research

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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors All the authors contributed equally to the design of the study. FM was involved in planning the study and in data management, and drafted the initial manuscript. AC contributed in planning the data analysis and in writing the manuscript. MC carried out the statistical analyses. AC, AB, IF, LM and MB supervised the study. All authors contributed to and have approved the final manuscript.

  • Funding The study was funded by the Lombardy Region (EPIFARM Project).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval No ethics committee approval is required in Italy for epidemiological studies using healthcare administrative databases for research purposes and with individuals identified by an anonymous patient code.

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

  • Data availability statement No data are available.

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