(U) Outpatient Antibiotic Prescribing in Early Life: A Population-Based Study Comparing Birth Cohorts from Denmark and Germany

Sunday, August 28, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 1020

Presenting Author(s)

Ulrike Haug
– Prof. Dr. sc. hum., Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany

Co-Author(s)

Oliver Scholle, PhD
– Postdoctoral research fellow, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
Lotte Rasmussen
– University of Southern Denmark, Odense C, Syddanmark, Denmark
Mette Reilev, MD PhD
– Researcher, University of Southern Denmark, Odense C, Syddanmark, Denmark
Jost Viebrock
– Leibniz Institute for Prevention Research and Epidemiology – BIPS, Germany

Background: Comparing antibiotic prescribing between countries can provide important insights into potential needs of improving antibiotic stewardship programs. Given the high prevalence of antibiotic use in early life, a focus on this age group is of particular interest.

Objectives: To compare outpatient antibiotic prescribing in early life between children born in Denmark (DK) vs. Germany (GER).

Methods: Using the Danish nationwide healthcare registries and the German Pharmacoepidemiological Research Database (GePaRD; claims data covering ~20% of the German population), we included children born between 2004 and 2016 and followed them from birth until end of enrollment or Dec 31, 2018, identifying outpatient antibiotic prescriptions. For each country, we determined the median time to first antibiotic prescription using Kaplan–Meier analyses. For the first two years of life, we calculated the prescription rate (number of prescriptions per 1,000 persons/year) and determined quality indicators of antibiotic prescribing (ratio of broad- to narrow-spectrum antibiotics [B/N ratio]; and access-to-watch index according to the WHO) based on the first prescription. All analyses were stratified by year of birth.

Results: Overall, the cohorts comprised ~0.8 (DK) and ~1.6 million (GER) children. In the 2016 birth cohort, the median time until first outpatient antibiotic prescription was ~21 (DK) and ~28 months (GER) and had increased by 50% (DK) and 59% (GER) compared to the 2004 birth cohort. The prescription rate was 617 (DK) and 477 (GER) in the 2016 birth cohort and had decreased by 45% (in both countries) compared to the 2004 birth cohort. In the 2016 birth cohort, the B/N ratio was 0.15 (DK) and 3.93 (GER); and the access-to-watch index was 19.5 (DK) and 1.1 (GER). The B/N ratio was consistently low for Denmark, while it almost doubled for Germany over time.

Conclusions: Over the first two years of life, children born in Denmark received antibiotics markedly earlier and more frequently than in Germany, while quality indicators of antibiotic prescribing were more favorable in Denmark. Our findings suggest a potential need of critical reflection on the improvement of antibiotic stewardship in pediatrics in both countries.