Outpatient Antibiotic Prescribing Patterns in Children among Primary Healthcare Institutions in China: A Nationwide Retrospective Study, 2017-2019

Abstract

There is scarce evidence to demonstrate the pattern of antibiotic use in children in China. We aimed to describe antibiotic prescribing practices among children in primary healthcare institutions (PHIs) in China. We described outpatient antibiotic prescriptions for children in PHIs from January 2017 to December 2019 at both the national and diagnostic levels, utilizing the antibiotic prescribing rate (APR), multi-antibiotic prescribing rate (MAPR), and broad-spectrum prescribing rate (BAPR). Generalized estimating equations were adopted to analyze the factors associated with antibiotic use. Among the total 155,262.2 weighted prescriptions for children, the APR, MAPR, and BAPR were 43.5%, 9.9%, and 84.8%. At the national level, J01DC second-generation cephalosporins were the most prescribed antibiotic category (21.0%, N = 15,313.0), followed by J01DD third-generation cephalosporins (17.4%, N = 12,695.8). Watch group antibiotics accounted for 55.0% of the total antibiotic prescriptions (N = 52,056.3). At the diagnostic level, respiratory tract infections accounted for 67.4% of antibiotic prescriptions, among which prescriptions with diagnoses classified as potentially bacterial RTIs occupied the highest APR (55.0%). For each diagnostic category, the MAPR and BAPR varied. Age, region, and diagnostic categories were associated with antibiotic use. Concerns were raised regarding the appropriateness of antibiotic use, especially for broad-spectrum antibiotics.

Keywords: antibiotic use; appropriateness; broad-spectrum antibiotics; children; diagnostic classification.

Figure 1

Outpatient antibiotic prescriptions for children in primary healthcare institutions at the national level. (a) Classified under Anatomical Therapeutic and Chemical classification; (b) antibiotic prescriptions under Access, Watch, Reserve classification; (c) top ten antibiotics prescribed for children in primary healthcare institution. Note: J01AA, tetracyclines; J01CE, beta-lactamase-sensitive penicillins; J01CF, beta-lactamase-resistant penicillins; J01DB, first-generation cephalosporins; J01DF, second-generation cephalosporins; J01EC, third-generation cephalosporins; J01GB, aminoglycosides; J01X, other antibacterials; J01CA, penicillins with extended spectrum; J01CR, combinations of penicillins; J01DC, second-generation cephalosporins, other combinations; J01DD, third-generation cephalosporins and other combinations; J01FA, macrolides, lincosamides, and streptogramins; J01FF, other macrolides and lincosamides; J01M, quinolone antibacterials.

Figure 2

Predictors of the outpatient antibiotic prescribing for children in primary healthcare institutions in China, 2017–2019. (a) Predictor of antibiotic prescribing. (b) Predictor of multi-antibiotics prescribing. (c) Predictor of broad-spectrum antibiotic prescribing. Note: broad-spectrum antibiotics included combinations of penicillin with b-lactamase inhibitors (ATC J01CR), second- and third-generation cephalosporins (J01DC and J01DD), and macrolides except for erythromycin (J01F except for J01FA01).