Dynamic shifts in outpatient antibiotic prescribing for pediatric upper respiratory infections in South Korea, 2002-2019: A national cohort study.

BACKGROUND

Antibiotic resistance is a global health concern, driven by inappropriate use. Contemporary data on antibiotic prescribing patterns for pediatric upper respiratory infections (URIs) are needed to evaluate trends and guide stewardship efforts. We examined longitudinal trends in antibiotic prescribing for pediatric URIs in South Korea, stratified by antibiotic class and patient age group.

METHODS

We conducted a retrospective study using the National Health Insurance Service (NHIS) pediatric sample cohort in South Korea (2002-2019). The dataset included 639,702 outpatient visits with a primary URI diagnosis among 369,702 children < 18 years. Children with complex chronic conditions were excluded, and antibiotic prescriptions were grouped into six classes. Primary outcomes were the antibiotic prescribing rate (per URI visit) and antibiotic exposure days (per 1000 person-years), stratified by age group and antibiotic class. Temporal trends were assessed using joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC).

RESULTS

The proportion of antibiotic prescriptions for pediatric URIs declined from 80.2 % to 49.1 % (APC -0.27 % per year; 95 % CI -0.62-0.04). Narrow-spectrum penicillin use decreased, macrolide remained relatively stable, and broad-spectrum penicillin initially increased and later stabilized. Antibiotic exposure days per 1000 person-years increased overall (AAPC 1.88 %, 95 % CI 1.59-2.21), with the highest exposure in children aged 1-5 years, peaking around 2008 before gradually declining. Other age groups were largely stable.

CONCLUSION

Antibiotic prescribing declined modestly overall, while broad-spectrum penicillin increased and narrow-spectrum agents decreased, with exposure highest in children aged 1-5 years. Sustained outpatient stewardship is needed to reduce unnecessary use and prioritize narrow-spectrum therapy when indicated.