Analysis of antibiotic prescription in upper respiratory tract infections in children 0-4 years of age in primary care. Impact of age and health care setting.

Antibiotics are the most prescribed drugs in children in Europe. The aim was to evaluate the out-of-hospital prescription of antibiotics in children aged 0-4 years with acute upper respiratory tract infections (URTI) in a Spanish Health Area during the period 2014-2023, as well as to analyze the differences according to age and health care setting. Retrospective study with data obtained from the Primary Care Information System of the Castilla-La Mancha Public Health Service (SESCAM). They correspond to a health area composed of 23 basic health zones and 69 municipalities. The variables selected included age, sex, diagnoses, setting (rural or urban), year of prescription, and antibiotics prescribed. A total of. 120,868 antibiotics were prescribed, with a rate of antibiotic prescription during this period (pPR) in children aged 0-4 years with URTI of 688.1 prescriptions/1000 persons/year. Children aged 12-35 months had the highest pPR (851.5). The pPR in rural areas was higher than in urban areas in all the pathologies studied: tonsillitis (486.3 versus 321.5), otitis (262.2 versus 203.7), and nasopharyngitis (96.2 versus 58.6). Amoxicillin was the most commonly used antibiotic (pPR 400.5). In urban areas, the prescription of beta-lactamase sensitive penicillins was significantly higher than in rural areas (p < 0.05) and significantly lower for amoxicillin (p < 0.05), amoxicillin/clavulanic acid (p < 0.01), and azithromycin (p < 0.01).

Conclusions

Children aged 12-35 months received most of the antibiotic prescriptions, especially in rural areas. In urban areas, fewer and narrower-spectrum antibiotics are prescribed, with a lower use of amoxicillin/clavulanic acid and azithromycin. What is Known? • Antibiotics are the most commonly prescribed drugs in the pediatric population throughout Europe, with children aged 0-4 years, along with the population over 75 years of age, being the age groups where antibiotics are mostly used. • Upper respiratory tract infections and acute otitis media are the most common diseases for which antibiotics are prescribed. What is New? • In recent years, antibiotic prescription rates in children have decreased and the quality of prescriptions has improved, with fewer prescriptions of amoxicillin/clavulanic acid and azithromycin and an increased use of penicillin and amoxicillin. • Antibiotic prescription rates in children are higher in rural areas than in urban areas, with a greater tendency to use broad-spectrum antibiotics in the former.