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Changes in clinical indications for community antibiotic prescribing for children in the UK from 1996-2006: will the new NICE prescribing guidance on upper respiratory tract infections be ignored?
  1. Paula L Thompson (paula.thompson{at}pharmacy.ac.uk)
  1. Centre for Paediatric Pharmacy Research, United Kingdom
    1. Nikos Spyridis (n.spyridis{at}sgul.ac.uk)
    1. St George's Hospital, United Kingdom
      1. Mike Sharland (mike.sharland{at}stgeorges.nhs.uk)
      1. St George's Hospital, United Kingdom
        1. Ruth E Gilbert (r.gilbert{at}ich.ucl.ac.uk)
        1. UCL, United Kingdom
          1. Sonia Saxena (s.saxena{at}imperial.ac.uk)
          1. UCL, United Kingdom
            1. Paul F Long (paul.long{at}pharmacy.ac.uk)
            1. School of Pharmacy, United Kingdom
              1. Alan P Johnson (alan.johnson{at}hpa.org.uk)
              1. HPA, United Kingdom
                1. Ian C K Wong (ian.wong{at}staff-1.ulsop.ac.uk)
                1. School of Pharmacy, United Kingdom

                  Abstract

                  Objective: To analyse changes in the clinical indications for community antibiotic prescribing for children in the UK between 1996 and 2006 and relate these findings to the new NICE guidelines for the treatment of upper respiratory tract infections in children.

                  Study design: Retrospective cohort study.

                  Setting: The IMS Health Mediplus database.

                  Method: The IMS Health Mediplus database was used to obtain annual antibiotic prescribing rates and the associated clinical indications for patients aged 0 to 18 years between 1st January 1996 and 31st December 2006 in the UK.

                  Results: Antibiotic prescribing declined by 24% between 1996-2000, but rates increased again by 10% during the latter part of the study (2003-2006). Respiratory tract infection was the most common indication for which an antibiotic was prescribed, followed by "abnormal signs and symptoms", then ear and skin infections. Antibiotic prescriptions for respiratory tract infections have decreased by 31% (p: 0.01) attributed mainly to reduced prescribing for lower respiratory tract infections (56% decline, p<0.001) and specific upper respiratory tract infections including tonsillitis/pharyngitis (48% decline, p<0.001) and otitis (46% decline, p<0.001). Prescribing for non-specific upper respiratory tract infection increased by fourfold (p<0.001). Prescribing for "abnormal signs and symptoms" also increased significantly since 2001 (40% increase, p<0.001).

                  Conclusion: There has been a marked decrease in community antibiotic prescribing linked to the specific diagnoses of lower respiratory tract infection, tonsillitis, pharyngitis and otitis. Overall prescribing is now increasing again, but associated with non-specific upper respiratory tract infection diagnoses. These findings suggest that GPs may now be avoiding using diagnoses where formal guidance suggests antibiotic prescribing is not indicated. The new NICE guidance on upper respiratory tract infections is at risk of being ignored.

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