Clinical impact of reducing antibiotic prescribing in children

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Clinical impact of reducing antibiotic
prescribing in children

• Dr Mike Sharland
• Paediatric Infectious Diseases Unit,
• St Georges Hospital

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PPA paediatric data

• No age data available
• Mainly oral liquids including granules for
  reconstitution
• Low strength tablets and sachets e.g. amoxicillin
  125mg
• Other products which include paediatric in title
• Validated by random sampling

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Variation Between Strategic Health Authorities in
Prescribing of Phenoxymethylpenicillin Paediatric
Preparations (January 2002-December 2002)
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Changes in prescribing

• Change in clinical general practice prescribing
  advisors ?
• Advice DH, Guidelines?
• Changes in respiratory illness?
• Clinical impact URT complications
  mastoiditis, quinsy and rheumatic fever

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Time trend in prescribing of antibiotics to
children in general practice expressed as a
percentage of prescribing in 1993 pharmacy data
from Prescription Pricing Authority (PPA) and
general practice prescribing data from IMS
Disease Analyzer Mediplus

of prescribing in 1993
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Change in antibiotic prescribing to children by
age expressed as a percentage of all prescribing
of all prescribing to same age group
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Hospital admission rate/100000 for quinsy or
rheumatic fever in children age 0-14 years
(Hospital Episode Statistics for England
1993-2002)
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Age specific hospital admission rate/100000 for
mastoiditis or simple mastoidectomy in children
age 0-14 years (Hospital Episode Statistics for
England 1993-2002)
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? A real problem

• Consult rate for earache in GP 4800/100,000
  children/year
• NNT around 5000 reduction in prescriptions 5m
  with 100 additional cases of mastoiditis
• Relationship between mastoiditis, otitis media
  and antibiotic prescribing unclear

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? How low can we go

• UK now around 500 antibiotic prescriptions/1000
  children/year
• USA 1100 Holland 150
• Need improved information on identifying those at
  risk of complications from OM etc
• Enhanced vaccination strategies influenza,
  prevenar
• Long term linked paediatric clinical,
  microbiological and prescribing surveillance