From the Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Pediatr Infect Dis J. 2018 Nov;37(11):1112-1117. doi: 10.1097/INF.0000000000001961.
In Denmark, the use of amoxicillin is widespread among children, despite phenoxymethylpenicillin being recommended as first-line therapy. The reason for this apparent discrepancy is not fully understood. We aimed at evaluating prescribing patterns of antibiotics among Danish children 0-4 years of age, with emphasis on incidence of treatment episodes, choice of initial antibiotic treatment and switching patterns between different types of antibiotics.
We identified all children ≤4 years of age who filled a prescription of antibiotics from 2000 to 2015 according to the nationwide Danish National Prescription Registry. We estimated the incidence rate of episodes treated with antibiotics and the choice of initial antibiotic treatment over time. Further, we assessed the cumulative risk of switching within 0-3 days after initiating therapy.
We identified 3,481,684 antibiotic treatment episodes issued to 0- to 4-year-olds from 2000 to 2015. The incidence rate was stable until 2011 both among children 0-1 years of age (approximately 880/1000) and among children 2-4 years of age (approximately 610/1000), after which it dropped. Phenoxymethylpenicillin and, increasingly, amoxicillin were most frequently used as initial treatments (39% vs. 44%). Few switched from amoxicillin (1%) or phenoxymethylpenicillin (4.7%) within the first 3 days. Of those who switched from phenoxymethylpenicillin, 64% received amoxicillin as second-line treatment.
The incidence of episodes treated with antibiotics among Danish children 0-4 years of age has decreased considerably since 2011. In contrast to guideline recommendations, amoxicillin is the most frequently used initial treatment. Early switching between antibiotics is uncommon. Initiatives should address the extensive use of amoxicillin.
在丹麦，尽管推荐使用苯氧甲基青霉素作为一线治疗药物，但儿童中仍广泛使用阿莫西林。造成这种明显差异的原因尚不完全清楚。我们旨在评估丹麦 0-4 岁儿童抗生素的处方模式，重点关注治疗发作的发生率、初始抗生素治疗的选择以及不同类型抗生素之间的转换模式。
我们根据全国性的丹麦国家处方登记处，确定了 2000 年至 2015 年期间所有 4 岁以下儿童的抗生素处方。我们估计了随着时间的推移，用抗生素治疗的发作发生率和初始抗生素治疗的选择。此外，我们评估了在开始治疗后 0-3 天内转换的累积风险。
我们确定了 2000 年至 2015 年期间 0-4 岁儿童的 3481684 个抗生素治疗发作。在 0-1 岁儿童（约 880/1000）和 2-4 岁儿童（约 610/1000）中，2011 年之前，发生率保持稳定，之后下降。苯氧甲基青霉素和越来越多的阿莫西林是最常被用作初始治疗的药物（39%比 44%）。在最初的 3 天内，很少有从阿莫西林（1%）或苯氧甲基青霉素（4.7%）转换的。从苯氧甲基青霉素转换的患者中，64%接受阿莫西林作为二线治疗。
自 2011 年以来，丹麦 0-4 岁儿童抗生素治疗发作的发生率显著下降。与指南推荐相反，阿莫西林是最常用的初始治疗药物。抗生素之间的早期转换并不常见。应采取措施解决阿莫西林的广泛使用问题。
