Age-Specific Antibiotic Prescribing and Adherence to Guidelines in Pediatric Patients in Primary Care

Background: Most antibiotics in children are used to treat viral and self-limiting conditions. This study aims to compare physicians' adherence to guidelines on antibiotic prescribing in fever and in ear and respiratory infections to children in different age groups in the Netherlands. Methods: Data were used from the NIVEL Primary Care Database. For all pediatric episodes of fever, acute otitis media (AOM), streptococcal pharyngitis (strep throat), sinusitis, acute tonsillitis, acute bronchitis/bronchiolitis and pneumonia in 2012, we determined whether national guidelines were followed with regard to whether an antibiotic was prescribed, and the type of antibiotic. Results: For diagnoses that generally do not require antibiotics, more prescriptions were found in adolescents' episodes compared with children 0-4 and 5-11 years of age, respectively, (bronchitis: 52.0% versus 42.4% and 42.7%, and fever: 16.8% versus 9.0% and 14.2%). The same was true for diagnoses that require antibiotics (strep throat: 76.5% versus 55.0% and 49.5%, pneumonia: 71.6% versus 60.2% and 69.8% and tonsillitis: 57.8% versus 54.8% and 49.7%), except for AOM (43.9% versus 52.4% and 39.6%). First-choice amoxicillin was prescribed more frequently in children 0-4 years of age than in age groups 5-11 and 11-17 years (AOM: 88.0% versus 83.2% and 81.8%, and pneumonia:74.7% versus 57.2% and 53.8%). First-choice narrow-spectrum penicillins were prescribed more often in adolescents than in age groups 0-4 and 5-11 years (strep throat: 72.0% versus 63.6%, and 60.9% and tonsillitis: 67.9% versus 33.1 and 45.9%). Conclusions: Concerning adherence patterns include high antibiotic rates for bronchitis, particularly in adolescents, and underuse of narrow-spectrum penicillins in the 0-4 years group.