Open Access Open Badges Research article

Systemic antibiotic prescribing to paediatric outpatients in 5 European countries: a population-based cohort study

Jakob Holstiege1, Tania Schink1, Mariam Molokhia2, Giampiero Mazzaglia3, Francesco Innocenti34, Alessandro Oteri5, Irene Bezemer6, Elisabetta Poluzzi7, Aurora Puccini7, Sinna Pilgaard Ulrichsen8, Miriam C Sturkenboom5, Gianluca Trifirò59 and Edeltraut Garbe1*

Author Affiliations

1 Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstr. 30, 28359 Bremen, Germany

2 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Department of Primary Care and Public Health Sciences, Room 713, 7th Floor, Capital House Weston St, SE1 3QD London, UK

3 Health search, Italian College of General Practitioners, Via Sestese, 61 - 50141 Florence, Italy

4 Agenzia regionale di sanità della Toscana, Via Dazzi, 1 - 50141 Florence, Italy

5 Department of Medical Informatics, Erasmus University Medical Center, Dr. Molewaterplein, 50 3015 GE Rotterdam, The Netherlands

6 The PHARMO Institute, Van Deventerlaan 30-40, 3528 AE Utrecht, The Netherlands

7 Department of Pharmacology, University of Bologna, Via Irnerio, 48, 40126 Bologna, Italy

8 Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus, Denmark

9 Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Messina, Italy

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BMC Pediatrics 2014, 14:174  doi:10.1186/1471-2431-14-174

Published: 5 July 2014



To describe the utilisation of antibiotics in children and adolescents across 5 European countries based on the same drug utilisation measures and age groups. Special attention was given to age-group-specific distributions of antibiotic subgroups, since comparison in this regard between countries is lacking so far.


Outpatient paediatric prescriptions of systemic antibiotics during the years 2005-2008 were analysed using health care databases from the UK, the Netherlands, Denmark, Italy and Germany. Annual antibiotic prescription rates per 1,000 person years were estimated for each database and stratified by age (≤4, 5-9, 10-14, 15-18 years). Age-group-specific distributions of antibiotic subgroups were calculated for 2008.


With 957 prescriptions per 1000 person years, the highest annual prescription rate in the year 2008 was found in the Italian region Emilia Romagna followed by Germany (561), the UK (555), Denmark (481) and the Netherlands (294). Seasonal peaks during winter months were most pronounced in countries with high utilisation. Age-group-specific use varied substantially between countries with regard to total prescribing and distributions of antibiotic subgroups. However, prescription rates were highest among children in the age group ≤4 years in all countries, predominantly due to high use of broad spectrum penicillins.


Strong increases of antibiotic prescriptions in winter months in high utilising countries most likely result from frequent antibiotic treatment of mostly viral infections. This and strong variations of overall and age-group-specific distributions of antibiotic subgroups across countries, suggests that antibiotics are inappropriately used to a large extent.

Drug utilisation study; Antibiotic resistance; Paediatric; Prescription rate; Cephalosporins; Macrolides; Penicillins; Electronic healthcare database