Objective Trends in antibiotic prescriptions among children attending day-care centres (DCCs) were studied before and after campaigns promoting prudent antibiotic use and the introduction of pneumococcal conjugate vaccine.

Design and setting Cross-sectional studies were conducted on a two-stage cluster sample of children aged 3 months to 4 years attending DCCs the Alpes Maritimes in France between January and March in 1999, 2004 and 2008. Antibiotic treatments given in the previous 3 months and their indications were studied.

Interventions A local public health intervention promoting prudent paediatric antibiotic prescriptions was implemented in 2000 and followed by a nationwide campaign in 2002.

Main outcome measures Trends in the number and type of antibiotic prescriptions, and indications for antibiotic use, over the study period.

Results 217, 254 and 279 children provided information in 1999, 2004 and 2008, respectively. The proportion of children who had received antibiotics within the previous 3 months fell from 58.5% (95% CI 51.7% to 65.2%) in 1999 to 29.7% (95% CI 24.4 to 35.5) in 2008. The number of treated episodes/child dropped from 0.99±1.14 to 0.35±1.16 (p<0.00001). Otitis media accounted for an increasing percentage of antibiotic use, rising from 35.3% (95% CI 29.0% to 42.2%) to 56.0% (95% CI 46.3% to 66.6%). Prescriptions for third‑generation cephalosporins increased from 26.0% (95% CI 20.4% to 32.5%) to 49.5% (95% CI 39.2% to 59.7%).

Conclusions Paediatric antibiotic prescriptions dropped significantly following campaigns and the introduction of pneumococcal immunisation in France. Improvements are still needed regarding indications and choice of compounds.