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

2. 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

3. Aim Antibiotic prescribing behaviour in an Irish paediatric population –Overall rates and trend from 2004-2008 –Cost –Choice of agents –Comparison to European prescribing behaviour

4. 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) 2004-2008 –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

5. Overall rates and trend from 2004-2008

6. Overall rates and trend from 2004-2008 by gender

7. Overall rates and trend from 2004-2008 by age

8. Cost YearNet ingredient cost (€)Approx cost to State (€ +25%) 20042, 318 8592, 898 574 20052, 263 5522, 829 440 20062, 629 6203, 287 025 20072, 847 4253, 559 294 20082, 864 2263, 580 283

9. Choice of agents

10. 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

11. Comparison to EU rates StudyCountryAge groupPrevalence Rate GMS data (2008)Ireland0-15578/1000 Lusini (2009)Italy0-19512/1000 Lusini (2009)Denmark0-19328/1000 de Jong (2008)Netherlands0-17178/1000 Ekins-Daukes (2002) Scotland0-16142/1000 GMS data (2008)Ireland0-4751/1000 Schindler (2003)Germany0-6429/1000

12. Comparison to EU: Italy and the Netherlands Ireland (2008) Prescriptions % Italy (2003) Prescriptions % Netherlands (1998) Prescriptions % Amoxicillin28.625.848.4 Co-amoxiclav34.638.79.8 Cefaclor11.718.0- Clarithromycin5.220.56.7 Phenoxymethylpenicillin5.2-7.3

13. 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

14. 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

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