Antibiotic prescribing for children. Too much and too little? Retrospective observational study in primary care

S. Ekins-Daukes, James Stuart McLay, Michael William Taylor, Colin Richard Simpson, Peter Joseph Benedict Helms

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Aims To investigate the extent of dose-related off-label antibiotic paediatric prescribing in primary care and to identify any potential clinical effects, particularly of lower than recommended dose prescribing.

Methods Assessment of antibiotic prescribing in 168 396 children aged 0-16 years for the year 1999-2000 from data retrieved from 158 general practices using the national Scottish primary care computer system GPASS. The setting was general practices in Scotland.

Results During the study period at least one course of antibiotics was prescribed to 23 911 children (14.2%). A total of 4582 (19.2%) children were prescribed an antibiotic dose of less than that recommended in the Summary of Product Characteristics (SPC). The number of children prescribed an antibiotic at less than recommended dose increased with age from 1154 (11.8%) aged 0-4 years to 1827 (30.0%) in the 12-16 years age group. For each antibiotic, prescribing lower than recommended dose occurred most frequently at those ages at which a dose increase was recommended in the SPC. Antibiotic prescribing at less than the recommended dose was not associated with an increased return rate for further antibiotic prescriptions during the following month, but in 5-11-year-olds was associated with a significant 48% increase in the total number of antibiotic courses prescribed during the study year {mean = 2.09 [95% confidence interval (CI) 1.79, 2.39]vs. 1.41 [95% CI 1.35, 1.47]}. Antibiotic prescribing at doses higher than recommended occurred less frequently (1.6%) and decreased steadily with age.

Conclusions Off-label prescribing of antibiotics at less than the recommended dose in children is common in primary care and occurs primarily as the result of a failure to increase antibiotic dosage with age in line with SPC recommendations. Adoption of a uniform approach to SPC age banding for antibiotic dose increments would reduce the frequency of dose-related off-label antibiotic prescribing in children and help minimize the potential for the development of antibiotic resistance.

Original languageEnglish
Pages (from-to)92-95
Number of pages3
JournalBritish Journal of Clinical Pharmacology
Volume56
Issue number1
DOIs
Publication statusPublished - 2003

Keywords

  • antibiotics
  • children
  • off-label
  • prescribing
  • RESISTANT STREPTOCOCCUS-PNEUMONIAE
  • DRUGS
  • PRESCRIPTION
  • CARRIAGE

Cite this

Antibiotic prescribing for children. Too much and too little? Retrospective observational study in primary care. / Ekins-Daukes, S.; McLay, James Stuart; Taylor, Michael William; Simpson, Colin Richard; Helms, Peter Joseph Benedict.

In: British Journal of Clinical Pharmacology, Vol. 56, No. 1, 2003, p. 92-95.

Research output: Contribution to journalArticle

Ekins-Daukes, S. ; McLay, James Stuart ; Taylor, Michael William ; Simpson, Colin Richard ; Helms, Peter Joseph Benedict. / Antibiotic prescribing for children. Too much and too little? Retrospective observational study in primary care. In: British Journal of Clinical Pharmacology. 2003 ; Vol. 56, No. 1. pp. 92-95.
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abstract = "Aims To investigate the extent of dose-related off-label antibiotic paediatric prescribing in primary care and to identify any potential clinical effects, particularly of lower than recommended dose prescribing.Methods Assessment of antibiotic prescribing in 168 396 children aged 0-16 years for the year 1999-2000 from data retrieved from 158 general practices using the national Scottish primary care computer system GPASS. The setting was general practices in Scotland.Results During the study period at least one course of antibiotics was prescribed to 23 911 children (14.2{\%}). A total of 4582 (19.2{\%}) children were prescribed an antibiotic dose of less than that recommended in the Summary of Product Characteristics (SPC). The number of children prescribed an antibiotic at less than recommended dose increased with age from 1154 (11.8{\%}) aged 0-4 years to 1827 (30.0{\%}) in the 12-16 years age group. For each antibiotic, prescribing lower than recommended dose occurred most frequently at those ages at which a dose increase was recommended in the SPC. Antibiotic prescribing at less than the recommended dose was not associated with an increased return rate for further antibiotic prescriptions during the following month, but in 5-11-year-olds was associated with a significant 48{\%} increase in the total number of antibiotic courses prescribed during the study year {mean = 2.09 [95{\%} confidence interval (CI) 1.79, 2.39]vs. 1.41 [95{\%} CI 1.35, 1.47]}. Antibiotic prescribing at doses higher than recommended occurred less frequently (1.6{\%}) and decreased steadily with age.Conclusions Off-label prescribing of antibiotics at less than the recommended dose in children is common in primary care and occurs primarily as the result of a failure to increase antibiotic dosage with age in line with SPC recommendations. Adoption of a uniform approach to SPC age banding for antibiotic dose increments would reduce the frequency of dose-related off-label antibiotic prescribing in children and help minimize the potential for the development of antibiotic resistance.",
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T1 - Antibiotic prescribing for children. Too much and too little? Retrospective observational study in primary care

AU - Ekins-Daukes, S.

AU - McLay, James Stuart

AU - Taylor, Michael William

AU - Simpson, Colin Richard

AU - Helms, Peter Joseph Benedict

PY - 2003

Y1 - 2003

N2 - Aims To investigate the extent of dose-related off-label antibiotic paediatric prescribing in primary care and to identify any potential clinical effects, particularly of lower than recommended dose prescribing.Methods Assessment of antibiotic prescribing in 168 396 children aged 0-16 years for the year 1999-2000 from data retrieved from 158 general practices using the national Scottish primary care computer system GPASS. The setting was general practices in Scotland.Results During the study period at least one course of antibiotics was prescribed to 23 911 children (14.2%). A total of 4582 (19.2%) children were prescribed an antibiotic dose of less than that recommended in the Summary of Product Characteristics (SPC). The number of children prescribed an antibiotic at less than recommended dose increased with age from 1154 (11.8%) aged 0-4 years to 1827 (30.0%) in the 12-16 years age group. For each antibiotic, prescribing lower than recommended dose occurred most frequently at those ages at which a dose increase was recommended in the SPC. Antibiotic prescribing at less than the recommended dose was not associated with an increased return rate for further antibiotic prescriptions during the following month, but in 5-11-year-olds was associated with a significant 48% increase in the total number of antibiotic courses prescribed during the study year {mean = 2.09 [95% confidence interval (CI) 1.79, 2.39]vs. 1.41 [95% CI 1.35, 1.47]}. Antibiotic prescribing at doses higher than recommended occurred less frequently (1.6%) and decreased steadily with age.Conclusions Off-label prescribing of antibiotics at less than the recommended dose in children is common in primary care and occurs primarily as the result of a failure to increase antibiotic dosage with age in line with SPC recommendations. Adoption of a uniform approach to SPC age banding for antibiotic dose increments would reduce the frequency of dose-related off-label antibiotic prescribing in children and help minimize the potential for the development of antibiotic resistance.

AB - Aims To investigate the extent of dose-related off-label antibiotic paediatric prescribing in primary care and to identify any potential clinical effects, particularly of lower than recommended dose prescribing.Methods Assessment of antibiotic prescribing in 168 396 children aged 0-16 years for the year 1999-2000 from data retrieved from 158 general practices using the national Scottish primary care computer system GPASS. The setting was general practices in Scotland.Results During the study period at least one course of antibiotics was prescribed to 23 911 children (14.2%). A total of 4582 (19.2%) children were prescribed an antibiotic dose of less than that recommended in the Summary of Product Characteristics (SPC). The number of children prescribed an antibiotic at less than recommended dose increased with age from 1154 (11.8%) aged 0-4 years to 1827 (30.0%) in the 12-16 years age group. For each antibiotic, prescribing lower than recommended dose occurred most frequently at those ages at which a dose increase was recommended in the SPC. Antibiotic prescribing at less than the recommended dose was not associated with an increased return rate for further antibiotic prescriptions during the following month, but in 5-11-year-olds was associated with a significant 48% increase in the total number of antibiotic courses prescribed during the study year {mean = 2.09 [95% confidence interval (CI) 1.79, 2.39]vs. 1.41 [95% CI 1.35, 1.47]}. Antibiotic prescribing at doses higher than recommended occurred less frequently (1.6%) and decreased steadily with age.Conclusions Off-label prescribing of antibiotics at less than the recommended dose in children is common in primary care and occurs primarily as the result of a failure to increase antibiotic dosage with age in line with SPC recommendations. Adoption of a uniform approach to SPC age banding for antibiotic dose increments would reduce the frequency of dose-related off-label antibiotic prescribing in children and help minimize the potential for the development of antibiotic resistance.

KW - antibiotics

KW - children

KW - off-label

KW - prescribing

KW - RESISTANT STREPTOCOCCUS-PNEUMONIAE

KW - DRUGS

KW - PRESCRIPTION

KW - CARRIAGE

U2 - 10.1046/j.1365-2125.2003.01835.x

DO - 10.1046/j.1365-2125.2003.01835.x

M3 - Article

VL - 56

SP - 92

EP - 95

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

SN - 0306-5251

IS - 1

ER -