Rates and Trends in Antibiotic Prescribing in Irish Children Receiving Free Medical Care Keogh C, Reulbach U, Motterlini N, Bennett K, and Fahey T.

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Presentation transcript:

Rates and Trends in Antibiotic Prescribing in Irish Children Receiving Free Medical Care Keogh C, Reulbach U, Motterlini N, Bennett K, and Fahey T

Introduction Antibiotics are the most commonly prescribed drug in paediatric populations Concern is growing worldwide over rates of antibiotic prescribing Limited research exists on prescribing trends in paediatric populations –Quality of prescribing –Rates and trends in prescribing

Aim Antibiotic prescribing behaviour in an Irish paediatric population –Overall rates and trend from –Cost –Choice of agents –Comparison to European prescribing behaviour

Methods Data was obtained from the General Medical Services (GMS) claims database –routinely collected dispensing data –patients receiving free medical care (means-tested) –represents about one-third of all Irish children –Socially disadvantaged are over-represented Systemic antibiotics (ATC code J01) –About 270,000 children per year –Age (0-4, 5-11 and 12-15) and gender –Net ingredient cost of drugs Calculated prevalence per 1000 GMS population

Overall rates and trend from

Overall rates and trend from by gender

Overall rates and trend from by age

Cost YearNet ingredient cost (€)Approx cost to State (€ +25%) 20042, , , , , , , , , ,

Choice of agents

Tetracycline –contra-indicated for children under 12, due to potential damage to teeth and bones and may result in bone growth retardation –GMS data (0-11 age group):3/100,000 population Ciprofloxacin –Ciprofloxacin is not recommended as a first line agent (linked to arthropathy) –GMS data (0-4 age group) 17/100,000 population

Comparison to EU rates StudyCountryAge groupPrevalence Rate GMS data (2008)Ireland /1000 Lusini (2009)Italy /1000 Lusini (2009)Denmark /1000 de Jong (2008)Netherlands /1000 Ekins-Daukes (2002) Scotland /1000 GMS data (2008)Ireland0-4751/1000 Schindler (2003)Germany0-6429/1000

Comparison to EU: Italy and the Netherlands Ireland (2008) Prescriptions % Italy (2003) Prescriptions % Netherlands (1998) Prescriptions % Amoxicillin Co-amoxiclav Cefaclor Clarithromycin Phenoxymethylpenicillin

Summary Overall rate of prescribing has remained relatively stable –No differences observed between males and females –Differences between age groups as expected Cost of antibiotic prescribing increased Preferred choice of agents changed Higher prevalence than EU comparisons –Choice of agent similar but different prescription rates

Discussion GMS data represents lower socioeconomic status groups. This may result in an over-inflation of prescription rates Lack of diagnostic information makes quality of prescribing difficult in this context There remains limited country specific and age specific data for paediatric populations –Wide heterogeneity across studies Research on quality of care for children may inform starting points for improved antibiotic prescribing in this population

Antibiotic Prescribing in Irish Children: A Preliminary Analysis Keogh C, Reulbach U, Motterlini N, Bennett K, and Fahey T