Trends in prescribing antibiotics for children in Dutch general practice

Objective: To assess changes in antibiotic prescribing patterns for children between 1987 and 2001, and to identify general practice characteristics associated with higher antibiotic prescribing rates. Methods: Cross-sectional national survey of Dutch general practice in 1987 and 2001. Data were used for all children aged 0-17 years; 86 577 children in 103 participating practices in 1987, and 76 010 children in 90 participating practices in 2001. Population-based, contact-based and disease-based antibiotic prescription rates were evaluated by age, gender and diagnosis. Practice characteristics associated with inappropriate broad-spectrum antibiotic prescription were identified. Results: Population-based prescription rates decreased from 300/1000 children (95% CI, 292-307) in 1987 to 232/1000 children in 2001 (95% CI, 228-235). In 1987, the contact-based prescription rate was 108/1000 contacts (95% CI, 106-111) and this was somewhat similar in 2001: 103/1000 contacts (95% CI, 101-105). In 2001, increased disease-based prescription rates were observed for acute otitis media, acute bronchitis, acute upper airway infections, acute tonsillitis and cough. Overall, non-recommended broad-spectrum antibiotics were prescribed more often in 2001 than in 1987 (87% in 1987 versus 90% in 2001, P < 0.001). Adjusted for other practice characteristics, general practitioners in single-handed practices prescribed 58% more broad-spectrum antibiotics inappropriately for upper airway infections than general practitioners in group practices. Conclusion: Antibiotic prescribing in children is still relatively low in the Netherlands. However, the prescription of broad-spectrum antibiotics for inappropriate diagnoses has increased, an unfavourable trend given the emerging bacterial resistance. Single-handed practices should especially be targeted to improve antibiotic prescribing in children.