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Yaeger JP, Fiscella KA, Ertefaie A, Alio AP. Persistent challenges in adjusting for race in analyses and a path forward. J Hosp Med 2024; 19:239-242. [PMID: 38017671 DOI: 10.1002/jhm.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Affiliation(s)
- Jeffrey P Yaeger
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin A Fiscella
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Amina P Alio
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
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2
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Knoke J, Raab R, Geyer K, Spies M, Haller B, Hauner H. Antibiotic Treatment During Pregnancy and the First Six Months Postpartum - a Secondary Analysis of the "Healthy Living in Pregnancy" (GeliS) Study. Geburtshilfe Frauenheilkd 2023; 83:850-861. [PMID: 37564896 PMCID: PMC10410684 DOI: 10.1055/a-2091-0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/06/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Antibiotic therapies for the treatment of bacterial infections pose a particular challenge during pregnancy and breastfeeding. For Germany, there is hardly any information on the frequency of antibiotic use during this phase. Our analysis uses data from the "Healthy Living in Pregnancy" (GeliS) study to describe antibiotic treatments during pregnancy and in the first six months after birth (postpartum), and to compare their use with existing recommendations. Methods This is a retrospective secondary analysis of the GeliS study. In the cluster randomized lifestyle intervention study, detailed information on antibiotic therapies during pregnancy and postpartum was collected using surveys. Chi-square tests and generalized estimating equations were used for evaluation. Results Of the 1636 women included in the analysis, 21% reported antibiotic treatment at least once during pregnancy (14%) or in the first six months postpartum (7%). During pregnancy, the antibiotic therapies of women increased from 1.7% in the first trimester to 6.5% in the third trimester. Common reasons for treatment were urinary tract infections (7.3% of women), ear, nose, throat (ENT) infections (3.6%), and birth complications (2.6%). The information on the prescribed preparations corresponded to the current recommendations. A significant increase in the frequency of treatment with antibiotics was observed in the lifestyle intervention group (p < 0.001), in participants without a partner (p < 0.001), and in women who breastfed their children (p = 0.005) or gave birth by caesarean section (p = 0.003) or prematurely (p = 0.012). Other socioeconomic or lifestyle factors were not significant. Conclusion Approximately one in five women receives at least one antibiotic treatment during pregnancy and breastfeeding that meets current treatment recommendations. Treatment with antibiotics is more common in premature births, caesarean sections, and breastfeeding women.
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Affiliation(s)
- Johanna Knoke
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Roxana Raab
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Kristina Geyer
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Monika Spies
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
| | - Bernhard Haller
- Institut für KI und Informatik in der Medizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Hans Hauner
- Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München,
Germany
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3
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Svalestuen S, Svendsen K, Eggen AE, Småbrekke L. Association of area-level education with the regional growth trajectories of rates of antibacterial dispensing to patients under 3 years in Norway: a longitudinal retrospective study. BMJ Open 2022; 12:e058491. [PMID: 36691217 PMCID: PMC9462082 DOI: 10.1136/bmjopen-2021-058491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/19/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To examine the association between area-level education and the local growth trajectories in antibacterial dispensing rates in Norwegian municipalities among children under 3 years old. DESIGN Retrospective, longitudinal study using individual primary care prescription data from the Norwegian Prescription Database for the period 2006-2016. Data were collected on the date of dispensing, the type and amount of antibiotic, the patient's age, sex and municipality of residence and linked to municipality-level statistics on education available from Statistics Norway. We used multilevel growth curve modelling, with a linear trend variable modelled as a random effect and a cross-level interaction between linear trends and the proportion of the population in the municipality having received a university or college education. SETTING The local government level in Norway. The sample includes all municipalities over the study period. OUTCOME MEASURE Number of dispensed antibacterial prescriptions per 100 children in individual primary care by municipality and year. RESULTS We identified a significant negative linear trend in the square root of the dispensing rate for children under 3 years old during the period. This trend varied between municipalities. A negative cross-level interaction term between population education levels and random trends showed that municipalities with an average level of population education saw a reduction in their square root dispensing rates of -0.053 (95% CI -0.066 to -0.039) prescriptions per 100 children. Each additional percentage point in population education contributed a further -0.0034 (95% CI -0.006 to -0.001) reduction to the square root dispensing rate. CONCLUSIONS Municipalities in which a larger proportion of the local population have high educational achievements have been more successful in reducing antibacterial dispensing rates in children under 3 years old. Adopting area-level strategies and addressing local community disadvantages may help to optimise practices and prescribing patterns across local communities.
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Affiliation(s)
- Sigbjørn Svalestuen
- Department of Social Science, UiT The Arctic University of Norway, Tromso, Troms og Finnmark, Norway
| | - Kristian Svendsen
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Troms og Finnmark, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Troms og Finnmark, Norway
| | - Lars Småbrekke
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Troms og Finnmark, Norway
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Kavanagh R, Rafiq M, Iqbal MN. Risk Factors for Attention Deficit Hypersensitivity Disorder in Children: A Systematic Review. Int J Dev Neurosci 2022; 82:569-575. [PMID: 35916062 DOI: 10.1002/jdn.10219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/19/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is among the most prevalent childhood disorders. This condition is characterized by impulsive behaviour, restlessness, and lack of concentration. Various researchers have come up with diverse conclusions concerning the risk factors of ADHD OBJECTIVE: However, there is a need for a comprehensive review to understand the risk factors associated with the development of ADHD METHODS: For this, Preferred Reporting Items for Systematic Reviews (PRISMA), the methodology was used to extract the findings. RESULTS The finding suggests that there are a variety of risk factors associated with women which may be responsible for the development of ADHD among children. The main four risk factors are; antibiotics use in early life, insufficient omega 3 and 6 in the body; disruption of gut microbiota; irregular circadian rhythm. These factors, which are discussed in-depth in the review, include factors that affect the development of the brain in children. CONCLUSION This review concludes that a variety of risk factors may contribute to the development of ADHD. Further, this review highlights not only the importance of metabolic, physiological but also highlights the importance of biopsychological aspects which leads to the development of ADHD among children. Studies should be conducted to check the impact of such factors holistically to minimize the risk of ADHD.
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Affiliation(s)
- Robert Kavanagh
- The School of Advanced Education, Research and Accreditation SAERA Castelln de la Plana, Spain
| | - Muhammad Rafiq
- The University of Lahore Ringgold standard institution - Department of Physiology, TheInstitute of Molecular Biology and Biotechnology, Lahore, Pakistan
| | - Muhammad Nasar Iqbal
- The University of Lahore Ringgold standard institution - Department of Psychology, Lahore School of Professional Studies, 1-KM Defense Road Lahore, Lahore Pakistan Sandhilianwali, Lahore, Pakistan
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5
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Fish‐Williamson A, Hahn‐Holbrook J, Hobbs M, Wallander J, Morton SMB. Prenatal antibiotic exposure in pregnancy and early childhood socioemotional development. JCPP ADVANCES 2022; 2:e12066. [PMID: 37431462 PMCID: PMC10242931 DOI: 10.1002/jcv2.12066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Antibiotic exposure in pregnancy is associated with reduced microbiome diversity in the infant gut. Given that recent research has shown that early microbiome health can impact child socioemotional development, we examined the relationship between prenatal antibiotic exposure in pregnancy and childhood socioemotional developmental outcomes using a large, nationally representative longitudinal dataset. Methods A sample of 4800 diverse families were assessed from the population cohort of the Growing Up in New Zealand Study (GUiNZ), which prospectively follows children starting in the last trimester of pregnancy into early childhood. Socioemotional development was measured using a composite score derived from seven commonly used socioemotional tasks administered between 9 months and 4.5 years of child age, addressing emotional expression understanding, regulation of emotions and behavior, and social problem solving and relationship skills. A national comprehensive pharmaceutical database was used to determine children's prenatal antibiotic exposure. Multivariate linear regressions models were used to examine the effects of the timing (trimester) and dosage (number of courses) of prenatal antibiotic exposure on socioemotional development, with and without statistically adjusting for confounding factors addressing maternal health, socioeconomic status, maternal age, and child sex. Results In unadjusted analyses, antibiotic exposure was inversely associated with child socioemotional development. However, after statistically adjusting for important confounds, socioemotional development was not associated with prenatal antibiotic exposure at any dosage or trimester of pregnancy (all β ≤ -0.02). Conclusion Prenatal antibiotic exposure does not appear to impact early childhood socioemotional development. Maternal health and sociodemographic factors are confounded with antibiotic exposure and socioemotional development, a fact that should be considered in future research examining the effects of prenatal antibiotic exposure on child health. These findings may be reassuring to families who are concerned about the long-term effects of antibiotics in pregnancy on child health outcomes.
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Affiliation(s)
- Adi Fish‐Williamson
- Department of psychological sciencesUniversity of California MercedMercedCaliforniaUSA
| | | | - Mark Hobbs
- Auckland City HospitalAucklandNew Zealand
| | - Jan Wallander
- Department of psychological sciencesUniversity of California MercedMercedCaliforniaUSA
| | - Susan M. B. Morton
- Growing Up in New Zealand, Centre for Longitudinal Research – He Ara Ki MuaThe University of AucklandAucklandNew Zealand
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Roof I, van der Hoek W, Oude Boerrigter L, Wielders CCH, Smit LAM. Use of Antibiotics among Residents Living Close to Poultry or Goat Farms: A Nationwide Analysis in The Netherlands. Antibiotics (Basel) 2021; 10:1346. [PMID: 34827284 PMCID: PMC8614970 DOI: 10.3390/antibiotics10111346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 01/21/2023] Open
Abstract
Prior regional studies found a high risk of pneumonia for people living close to poultry and goat farms. This epidemiological study in the Netherlands used nationwide antibiotic prescription data as a proxy for pneumonia incidence to investigate whether residents of areas with poultry and goat farms use relatively more antibiotics compared to areas without such farms. We used prescription data on antibiotics most commonly prescribed to treat pneumonia in adults and livestock farming data, both with nationwide coverage. Antibiotic use was expressed as defined daily doses per (4-digit Postal Code (PC4) area)-(age group)-(gender)-(month) combination for the year 2015. We assessed the associations between antibiotic use and farm exposure using negative binomial regression. The amoxicillin, doxycycline, and co-amoxiclav use was significantly higher (5-10% difference in use) in PC4 areas with poultry farms present compared to areas without, even after adjusting for age, gender, smoking, socio-economic status, and goat farm presence. The adjusted models showed no associations between antibiotic use and goat farm presence. The variables included in this study could only partly explain the observed regional differences in antibiotic use. This was an ecological study that precludes inference about causal relations. Further research using individual-level data is recommended.
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Affiliation(s)
- Inge Roof
- National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (W.v.d.H.); (L.O.B.); (C.C.H.W.)
| | - Wim van der Hoek
- National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (W.v.d.H.); (L.O.B.); (C.C.H.W.)
| | - Lisette Oude Boerrigter
- National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (W.v.d.H.); (L.O.B.); (C.C.H.W.)
| | - Cornelia C. H. Wielders
- National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (W.v.d.H.); (L.O.B.); (C.C.H.W.)
| | - Lidwien A. M. Smit
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands;
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Larsen SB, Jensen MLV, Bjerrum L, Siersma V, Bang CW, Jensen JN. Trend in antibiotic prescription to children aged 0-6 years old in the capital region of Denmark between 2009 and 2018: Differences between municipalities and association with socioeconomic composition. Eur J Gen Pract 2021; 27:257-263. [PMID: 34486909 PMCID: PMC8425679 DOI: 10.1080/13814788.2021.1965121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND To curb future antibiotic resistance it is important to monitor and investigate current prescription patterns of antibiotics. OBJECTIVES To examine trends in antibiotic prescription to children aged 0-6 years old and the association with socioeconomic status of municipalities in the Capital region of Denmark between 2009 and 2018. METHODS This is a register-based study combining data on antibiotic treatments from 2009 to 2018, inhabitant-data and socioeconomic municipality scores. Subjects were children aged 0-6 years, residing in the Capital Region of Denmark. The study quantifies the use of antibiotics as number of antibiotic treatments/1000 inhabitants/year (TIY), inhabitants defined as children aged 0-6. Socioeconomic status of the municipalities is evaluated by a score from 3 to 12. RESULTS The average TIY of the municipalities decreased from 741.2 [95%CI 689.3-793.2] in 2009 to 348.9 [329.4-368.4] in 2018. The difference between the highest and lowest prescribing municipalities was reduced from 648.3 TIY in 2009-212.5 TIY in 2018. The average increase in TIY per unit increase in socioeconomic municipality score changed from 20.05 [7.69-31.06] in 2009 to -4.58 [-16.02-5.60] in 2018, representing a decreasing association between socioeconomic municipality score and use of antibiotic in the respective municipalities. CONCLUSION The trend in antibiotic prescription to children aged 0-6 years old decreased substantially in all the investigated municipalities in the 10-year study period. Local differences in prescription rates declined towards a more uniform prescription pattern across municipalities and association with socioeconomic status of the municipalities was reduced.
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Affiliation(s)
- Sif Binder Larsen
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Maria Louise Veimer Jensen
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Lars Bjerrum
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Christine Winther Bang
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Jette Nygaard Jensen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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8
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Catalano AC, Pittet LF, Choo S, Segal A, Stephens D, Cranswick NE, Gwee A. Impact of Antibiotic Allergy Labels on Patient Outcomes in a Tertiary Paediatric Hospital. Br J Clin Pharmacol 2021; 88:1107-1114. [PMID: 34388858 DOI: 10.1111/bcp.15038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Antibiotic allergies are reported in 5 to 15% of children. This study aimed to evaluate the impact of common β-lactam antibiotic allergy labels (AALs) on hospital treatment, focussing on length of stay and appropriateness of antibiotic prescribing. STUDY DESIGN Retrospective cohort study over 21-months at the Royal Children's Hospital Melbourne, Australia. A subset of children with the most common β-lactam allergies, and who required admission for intravenous antibiotics over a 12-month period, was analysed for appropriateness of prescribing. Non-allergic patients were matched to evaluate associations between AALs and hospital treatment. RESULTS There were 98,912 children admitted over the study period, of whom 938 (1%) had at least one AAL on first admission. Of all encounters, 5145 (2.5%) were for children with AALs. The most common AALs were to amoxicillin and amoxicillin-clavulanic acid combinations (40.8%), cefalexin (14.4%) and trimethoprim-sulfamethoxazole (9.7%). For the subset, there were 66 admissions for children who required intravenous antibiotics. Documentation was adequate for 27% of AALs. Inappropriate prescribing occurred in almost half (47%). Hospital stay was longer for children with AALs (median 4.7 days; IQR 2.3 to 9.2) compared to non-allergic controls (median 3.9 days; IQR 1.9 to 6.8; P=0.02). Children with AALs were more likely to receive restricted antibiotics (aOR 3.03; 95%CI, 1.45 to 6.30; p=0.003). CONCLUSION This is the first study to demonstrate high rates of inappropriate prescribing in children with AALs. Children with AALs were significantly more likely to receive restricted antibiotics and had a longer length of stay compared with non-allergic controls.
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Affiliation(s)
- Anthony C Catalano
- Departments of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Laure F Pittet
- Departments of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Melbourne, Australia
| | - Sharon Choo
- Departments of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Allergy and Immunology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Ahuva Segal
- Departments of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Melbourne, Australia
| | - David Stephens
- Departments of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Noel E Cranswick
- Departments of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Amanda Gwee
- Departments of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
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9
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Hansen MB, Thorsted AB, Ivarsson S, Tyrstrup M, Hedin K, Melander E, Arpi M, Jakobsen HN, Brogaard E, Jensen JN. Antibiotic use in pre-school children and the correlation with adult educational levels in two Nordic counties: a replication of a 20-year-old study. Infect Dis (Lond) 2021; 53:281-290. [PMID: 33579169 DOI: 10.1080/23744235.2021.1882696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe the change of antibiotic prescribing in pre-school children in the municipalities of the former Copenhagen County in Denmark and Skåne County in Sweden after 20 years of antibiotic stewardship effort. Furthermore, the variation in the prescribing of antibiotics between the municipalities and the correlation between municipal adult educational level and antibiotic prescribing in pre-school children was assessed. METHODS In this ecological study, information on antibiotic prescribing in pre-school children was obtained from a central pharmacy settlement system in each Region. The antibiotic prescribing rate was expressed in defined daily doses per 1,000 inhabitants per day (DDD/TID) and number of prescriptions/1000 inhabitants. Information on municipal adult educational levels was obtained from Statistics Denmark and Statistics Sweden. RESULTS The antibiotic prescribing rate during 2017 was higher in the municipalities of Copenhagen County (5.6-7.9 DDD/TID) compared to the municipalities of Skåne County (4.2-6.6 DDD/TID). In 1998 a higher rate was found in Skåne County (9.6-17.7 DDD/TID) compared to Copenhagen County (8.0-12.9 DDD/TID). A non-significant negative correlation between adult educational levels and antibiotic prescribing was observed in the municipalities of Copenhagen County (r= -0.233, p = .352) while the correlation was positive in the municipalities of Skåne County (r= +0.410, p = .018). The same correlations were observed in 1998. CONCLUSION We found higher antibiotic prescribing in pre-school children in the municipalities of Copenhagen County compared to Skåne County in 2017, suggesting a possible overuse of antibiotics in Denmark. Further research should try to elucidate the reasons for the observed variation.
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Affiliation(s)
- Matilde Bøgelund Hansen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Anne Bonde Thorsted
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Stina Ivarsson
- Lundbergsgatan Primary Health Care Centre, Malmö, Sweden
| | - Mia Tyrstrup
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Katarina Hedin
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden.,Futurum, Region Jönköping County and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Melander
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Regional Centre of Communicable Disease Control, Malmö, Sweden
| | - Magnus Arpi
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Helle Neel Jakobsen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Emma Brogaard
- Department of Medicines Resource, Skåne Region, Malmö, Sweden
| | - Jette Nygaard Jensen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark.,Committee for the Prevention of Hospital Infections, Capital Region of Denmark, Copenhagen, Denmark
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10
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Ślęzak K, Dembiński Ł, Konefał A, Dąbrowski M, Mazur A, Peregud-Pogorzelska M, Wawrykow P, Konefał D, Peregud-Pogorzelski J. Impact of Selected Behavioral and Environmental Factors on the Antibiotic Therapy in Polish Children With Upper Respiratory Tract Infections. Front Pediatr 2021; 9:784265. [PMID: 34926354 PMCID: PMC8678461 DOI: 10.3389/fped.2021.784265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Antibiotic therapy must be carried out consistently and according to the guidelines. Viruses are the dominant cause of upper respiratory tract infections (URTIs) in children, as has been shown in many previous studies. Unnecessary antibiotic therapy should be avoided so that it does not affect patients' health and lead to the development of resistant bacterial strains. Here we report a national survey conducted in a group of 4,389 children to assess the impact of selected behavioral and environmental factors on antibiotic therapy in patients with URTIs. We found that selected environmental factors influenced the type of treatment. The place of residence, having siblings, an absence of vaccinations, the presence of allergies, and attendance at educational institutions were conducive to antibiotic therapy. These factors also influenced the frequency of hospitalization of children and their absence from nurseries, kindergartens, and schools, as well as the absence of their guardians from work.
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Affiliation(s)
- Katarzyna Ślęzak
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Łukasz Dembiński
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | | | - Mikołaj Dąbrowski
- Adult Spine Orthopaedics Department, Poznan University of Medical Sciences, Poznań, Poland
| | - Artur Mazur
- Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical College of Rzeszow University, Rzeszów, Poland
| | | | - Paweł Wawrykow
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland
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11
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Leong KSW, McLay J, Derraik JGB, Gibb S, Shackleton N, Taylor RW, Glover M, Audas R, Taylor B, Milne BJ, Cutfield WS. Associations of Prenatal and Childhood Antibiotic Exposure With Obesity at Age 4 Years. JAMA Netw Open 2020; 3:e1919681. [PMID: 31968118 PMCID: PMC6991276 DOI: 10.1001/jamanetworkopen.2019.19681] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022] Open
Abstract
Importance Although antibiotics are associated with obesity in animal models, the evidence in humans is conflicting. Objective To assess whether antibiotic exposure during pregnancy and/or early childhood is associated with the development of childhood obesity, focusing particularly on siblings and twins. Design, Setting, and Participants This cross-sectional national study included 284 211 participants (132 852 mothers and 151 359 children) in New Zealand. Data analyses were performed for 150 699 children for whom data were available, 30 696 siblings, and 4188 twins using covariate-adjusted analyses, and for 6249 siblings and 522 twins with discordant outcomes using fixed-effects analyses. Data analysis was performed November 2017 to March 2019. Exposure Exposure to antibiotics during pregnancy and/or early childhood. Main Outcomes and Measures The main outcome is odds of obesity at age 4 years. Anthropometric data from children born between July 2008 and June 2011 were obtained from the B4 School Check, a national health screening program that records the height and weight of 4-year-old children in New Zealand. These data were linked to antibiotics (pharmaceutical records) dispensed to women before conception and during all 3 trimesters of pregnancy and to their children from birth until age 2 years. Results The overall study population consisted of 132 852 mothers and 151 359 children (77 610 [51.3%] boys) who were aged 4 to 5 years when their anthropometrical measurements were assessed. Antibiotic exposure was common, with at least 1 course dispensed to 35.7% of mothers during pregnancy and 82.3% of children during the first 2 years of life. Results from covariate-adjusted analyses showed that both prenatal and early childhood exposures to antibiotics were independently associated with obesity at age 4 years, in a dose-dependent manner. Every additional course of antibiotics dispensed to the mothers yielded an adjusted odds ratio (aOR) of obesity in their children (siblings) of 1.02 (95% CI, 0.99-1.06), which was similar to the odds across pregnancy for the whole population (aOR, 1.06; 95% CI, 1.04-1.07). For the child's exposure, the aOR for the association between antibiotic exposure and obesity was 1.04 (95% CI, 1.03-1.05) among siblings and 1.05 (95% CI, 1.02-1.09) among twins. However, fixed-effects analyses of siblings and twins showed no associations between antibiotic exposure and obesity, with aORs of 0.95 (95% CI, 0.90-1.00) for maternal exposure, 1.02 (95% CI, 0.99-1.04) for child's exposure, and 0.91 (95% CI, 0.81-1.02) for twins' exposure. Conclusions and Relevance Although covariate-adjusted analyses demonstrated an association between antibiotic exposure and odds of obesity, further analyses of siblings and twins with discordant outcomes showed no associations. Thus, these discordant results likely reflect unmeasured confounding factors.
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Affiliation(s)
- Karen S. W. Leong
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start National Science Challenge, Auckland, New Zealand
| | - Jessica McLay
- A Better Start National Science Challenge, Auckland, New Zealand
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | - José G. B. Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start National Science Challenge, Auckland, New Zealand
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Sheree Gibb
- A Better Start National Science Challenge, Auckland, New Zealand
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Nichola Shackleton
- A Better Start National Science Challenge, Auckland, New Zealand
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | - Rachael W. Taylor
- A Better Start National Science Challenge, Auckland, New Zealand
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Marewa Glover
- A Better Start National Science Challenge, Auckland, New Zealand
- Centre of Research Excellence, Indigenous Sovereignty and Smoking, Auckland, New Zealand
| | - Rick Audas
- A Better Start National Science Challenge, Auckland, New Zealand
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Barry Taylor
- A Better Start National Science Challenge, Auckland, New Zealand
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Barry J. Milne
- A Better Start National Science Challenge, Auckland, New Zealand
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | - Wayne S. Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start National Science Challenge, Auckland, New Zealand
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Breithaupt L, Köhler-Forsberg O, Larsen JT, Benros ME, Thornton LM, Bulik CM, Petersen L. Association of Exposure to Infections in Childhood With Risk of Eating Disorders in Adolescent Girls. JAMA Psychiatry 2019; 76:800-809. [PMID: 31017632 PMCID: PMC6487907 DOI: 10.1001/jamapsychiatry.2019.0297] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Infections are recognized as playing a critical role in the risk of psychiatric disorders and suicidal behavior; however, few studies have evaluated the risk of eating disorders. OBJECTIVE To evaluate the association of hospitalization for infections and treatment with anti-infective agents with the risk of an eating disorder diagnosis. DESIGN, SETTING, AND PARTICIPANTS A nationwide, population-based, prospective cohort study of 525 643 girls born from January 1, 1989, to December 31, 2006, and followed up until December 31, 2012, was conducted using individual-level data drawn from Danish longitudinal registers. Data were analyzed from January 15 to June 15, 2018, using survival analysis models and adjusted for age, calendar period, parental educational level, and parental history of psychiatric illness. EXPOSURES Hospital admission for infections and prescribed anti-infective agents for infections. MAIN OUTCOMES AND MEASURES The main outcome of interest was diagnosis of an eating disorder (anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified) in a hospital, outpatient clinic, or emergency department setting. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and accompanying 95% CIs. RESULTS The study population consisted of 525 643 adolescent girls: 2131 received a diagnosis of anorexia nervosa (median [range] age, 15.2 [8.6-21.3] years), 711 received a diagnosis of bulimia nervosa (median [range] age, 17.9 [13.4-22.7] years), and 1398 received a diagnosis of an eating disorder not otherwise specified (median [range] age, 15.6 [8.6-21.6] years). A total of 525 643 adolescent girls were followed up for 4 601 720.4 person-years until a mean age of 16.2 years (range, 10.5-22.7 years). Severe infections that required hospitalization were associated with an increased risk of a subsequent diagnosis of anorexia nervosa by 22% (HR, 1.22; 95% CI, 1.10-1.35), bulimia nervosa by 35% (HR, 1.35; 95% CI, 1.13-1.60), and eating disorder not otherwise specified by 39% (HR, 1.39; 95% CI, 1.23-1.57) compared with adolescent girls without hospitalizations for infections. Infections treated with anti-infective agents were associated with an increased risk of a subsequent diagnosis of anorexia nervosa by 23% (HR, 1.23; 95% CI, 1.10-1.37), bulimia nervosa by 63% (HR, 1.63; 95% CI, 1.32-2.02), and eating disorder not otherwise specified by 45% (HR, 1.45; 95% CI, 1.25-1.67) compared with adolescent girls without infections treated with anti-infective agents. CONCLUSIONS AND RELEVANCE The findings suggest that hospital-treated infections and less severe infections treated with anti-infective agents are associated with increased risk of subsequent anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified and that future studies should investigate whether these associations are causal and identify the exact mechanisms between infections and subsequent inflammatory processes with eating disorders.
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Affiliation(s)
- Lauren Breithaupt
- Department of Psychology, George Mason University, Fairfax, Virginia,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Risskov, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark,Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Janne Tidselbak Larsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark,National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Michael E. Benros
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark,Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laura Marie Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Liselotte Petersen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark,National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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13
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Mölter A, Belmonte M, Palin V, Mistry C, Sperrin M, White A, Welfare W, Van Staa T. Antibiotic prescribing patterns in general medical practices in England: Does area matter? Health Place 2018; 53:10-16. [PMID: 30031949 DOI: 10.1016/j.healthplace.2018.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/25/2018] [Accepted: 07/12/2018] [Indexed: 11/19/2022]
Abstract
Antimicrobial resistance is an important public health concern. As most antibiotics are prescribed in primary care, understanding prescribing patterns in General Medical (GP) practices is vital. The aim of this study was a spatial pattern analysis of antibiotic prescribing rates in GP practices in England and to examine the association of potential clusters with area level socio-economic deprivation. The pattern analysis identified a number of hot and cold spots of antibiotic prescribing, with hot spots predominantly in the North of England. Spatial regression showed that patient catchments of hot spot practices were significantly more deprived than patient catchments of cold spot practices, especially in the domains of income, employment, education and health. This study suggests the presence of area level drivers resulting in clusters of high and low prescribing. Consequently, area level strategies may be needed for antimicrobial stewardship rather than national level strategies.
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Affiliation(s)
- Anna Mölter
- Greater Manchester Connected Health Cities, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK.
| | - Miguel Belmonte
- Greater Manchester Connected Health Cities, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Victoria Palin
- Greater Manchester Connected Health Cities, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Chirag Mistry
- Greater Manchester Connected Health Cities, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Matthew Sperrin
- Greater Manchester Connected Health Cities, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Andrew White
- NHS Greater Manchester Shared Service, Ellen House, Waddington Street, Oldham OL9 6 EE, UK
| | - William Welfare
- Public Health England North West, 3 Piccadilly Place, London Road, Manchester M1 3BN, UK
| | - Tjeerd Van Staa
- Greater Manchester Connected Health Cities, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
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Mali NB, Deshpande SP, Tullu MS, Deshmukh CT, Gogtay NJ, Thatte UM. A Prospective Antibacterial Utilization Study in Pediatric Intensive Care Unit of a Tertiary Referral Center. Indian J Crit Care Med 2018; 22:422-426. [PMID: 29962742 PMCID: PMC6020630 DOI: 10.4103/ijccm.ijccm_365_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: Antibacterials are commonly prescribed to Pediatric Intensive Care Unit (PICU) patients. However, inappropriate antibacterial prescriptions lead to increases in antibacterial resistance, treatment cost, duration of treatment, and poor clinical outcome. The antibacterial utilization study assesses the prescription patterns and if necessary recommends the interventions to improve antibacterial prescriptions. Hence, the present prospective groundwork was conducted. Materials and Methods: The study was conducted over the period of 6 months (April 18 to October 20, 2014). The demographics and drug use details were captured daily from patients admitted to PICU to assess World Health Organization indicators. Results: A total of 200 patients enrolled, among them 119 males and 81 females. There were 12.46 (±6.16) drugs prescribed per patient, of which 2.38 (±1.48) were antibacterials. Among the total drug prescribed, 18.49% were antibacterials and 97% patients received at least one antibacterial. Ceftriaxone (49.48%) was the most commonly prescribed antibacterial, while imipenem (2.58%) and colistin (2.06%) use was very low. A total of 80.95% antibacterials were prescribed by generic name, 94.88% were administered intravenously, and 80.76% were prescribed from hospital pharmacy. The average length of PICU stay was 6.15 days (±6.20), the average length of antibacterial treatment was 6.08 days (±6.27), and the average length of empirical antibacterial treatment was 5.50 days (±5.40). The cost of antibacterial therapy per patient was Indian rupees 824.64 (±235.35). In 27 patients, bacterial culture test was positive and of whom 21 received antibacterials as per sensitivity pattern. Conclusions: The use of antibacterials was not indiscriminately high but more prescriptions per sensitivity pattern are required.
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Affiliation(s)
- Nitin B Mali
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Siddharth P Deshpande
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Milind S Tullu
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Chandrahas T Deshmukh
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nithya J Gogtay
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Urmila M Thatte
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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15
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Omulo S, Thumbi SM, Lockwood S, Verani JR, Bigogo G, Masyongo G, Call DR. Evidence of superficial knowledge regarding antibiotics and their use: Results of two cross-sectional surveys in an urban informal settlement in Kenya. PLoS One 2017; 12:e0185827. [PMID: 28968447 PMCID: PMC5624622 DOI: 10.1371/journal.pone.0185827] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/20/2017] [Indexed: 01/08/2023] Open
Abstract
We assessed knowledge and practices related to antibiotic use in Kibera, an urban informal settlement in Kenya. Surveys was employed at the beginning (entry) and again at the end (exit) of a 5-month longitudinal study of AMR. Two-hundred households were interviewed at entry, of which 149 were also interviewed at exit. The majority (>65%) of respondents in both surveys could name at least one antibiotic, with amoxicillin and cotrimoxazole jointly accounting for 85% and 77% of antibiotics mentioned during entry and exit, respectively. More than 80% of respondents felt antibiotics should not be shared or discontinued following the alleviation of symptoms. Nevertheless, 66% and 74% of respondents considered antibiotics effective for treating colds and flu in the entry and exit surveys, respectively. There was a high (87%, entry; 70% exit) level of reported antibiotic use (past 12 months) mainly for colds/flu, coughs and fever, with >80% of respondents obtaining antibiotics from health facilities and pharmacies. Less than half of respondents remembered getting information on the correct use of antibiotics, although 100% of those who did reported improved attitudes towards antibiotic use. Clinicians and community pharmacists were highly trusted information sources. Paired household responses (n = 149) generally showed improved knowledge and attitudes by the exit survey although practices were largely unchanged. Weak agreement (κ = -0.003 to 0.22) between survey responses suggest both that unintended learning had not occurred, and that participant responses were not based on established knowledge or behaviors. Targeted public education regarding antibiotics is needed to address this gap.
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Affiliation(s)
- Sylvia Omulo
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
- Community Health Analytics Initiative, Washington State University, Pullman, WA, United States of America
| | - Samuel M. Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Svetlana Lockwood
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
| | - Jennifer R. Verani
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Godfrey Bigogo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Geoffrey Masyongo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Douglas R. Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
- Community Health Analytics Initiative, Washington State University, Pullman, WA, United States of America
- The Nelson Mandela African Institute for Science and Technology, Arusha, Tanzania
- * E-mail:
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16
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Renton K, Low A. Response: Slykerman et al.'s antibiotics in the first year of life and subsequent neurocognitive outcome. Acta Paediatr 2017; 106:1009. [PMID: 28231389 DOI: 10.1111/apa.13795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Kate Renton
- Paediatrics, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Allison Low
- Paediatrics, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
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17
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Timm S, Schlünssen V, Olsen J, Ramlau-Hansen CH. Prenatal antibiotics and atopic dermatitis among 18-month-old children in the Danish National Birth Cohort. Clin Exp Allergy 2017; 47:929-936. [DOI: 10.1111/cea.12916] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/10/2017] [Accepted: 03/01/2017] [Indexed: 12/12/2022]
Affiliation(s)
- S. Timm
- Department of Public Health; Aarhus University; Aarhus Denmark
| | - V. Schlünssen
- Department of Public Health; Aarhus University; Aarhus Denmark
- National Research Center for Working Environment; Copenhagen Denmark
| | - J. Olsen
- Department of Clinical Epidemiology; Aarhus University; Aarhus Denmark
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18
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Kalungia AC, Burger J, Godman B, Costa JDO, Simuwelu C. Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia. Expert Rev Anti Infect Ther 2016; 14:1215-1223. [PMID: 27548801 DOI: 10.1080/14787210.2016.1227702] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In Zambia, antibiotics are categorized as prescription-only medicines. Antibiotics dispensed without a prescription pose a public health threat, which is a concern. Consequently, the aim is to ascertain the extent of non-prescription sales and dispensing of antibiotics in community pharmacies in Zambia. METHODS The practice of non-prescription sale and dispensing were assessed in 73 randomly selected community retail pharmacies, using a structured interviewer-administered questionnaire with simulated case scenarios. RESULTS Majority (97%) stated that clients frequently requested non-prescribed antibiotics. Interviewees usually asked clients' indications (94%), counselled on dosing (96%) and suggested changes to antibiotic choices (97%). All (100%) dispensed non-prescribed antibiotics. Commonly dispensed antibiotics included amoxicillin (52%), cotrimoxazole (25%) and metronidazole (23%). Non-prescription sale and dispensing of antibiotics was significantly associated with interviewees' professional qualification in four out of five simulations. CONCLUSION Non-prescription sale and dispensing of antibiotics is widespread in Zambia. Concerted public and professional interventions are needed coupled with stronger regulatory enforcement to reduce this.
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Affiliation(s)
| | - Johanita Burger
- b Medicine Usage in South Africa (MUSA), Faculty of Health Sciences , North-West University (Potchefstroom campus) , Potchefstroom , South Africa
| | - Brian Godman
- c Division of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden.,d Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Juliana de Oliveira Costa
- e SUS Collaborating Centre - Health Technology Assessment & Excellence in Health, Department of Social Pharmacy, College of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Brazil
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19
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Jensen JN, Bjerrum L, Boel J, Jarløv JO, Arpi M. Parents' socioeconomic factors related to high antibiotic prescribing in primary health care among children aged 0-6 years in the Capital Region of Denmark. Scand J Prim Health Care 2016; 34:274-81. [PMID: 27408984 PMCID: PMC5036017 DOI: 10.1080/02813432.2016.1207145] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate the distribution of antibiotic prescriptions in primary health care among children aged 0-6 years and its association with socioeconomic factors. DESIGN A cross-sectional study describing antibiotic prescriptions and socioeconomic factors, using different population-based registers from Statistics Denmark. SETTING Antibiotic prescriptions in 2012 from primary health care in the Capital Region of Denmark. SUBJECTS The population of children aged 0-6 years (n = 139,398) in the Capital Region of Denmark. MAIN OUTCOME MEASURES High use of antibiotics identified by number of antibiotic prescriptions (≥ 3 prescriptions per year) and defined daily doses (DDD). A multinomial logistic regression analysis estimating the association between high antibiotic use and parents' education, employment status, income, child's sex, and ethnic background. RESULTS Ten percent of children accounted for 25% of the total use DDD. There was a clear tendency that the risk for high antibiotic use increased as parental educational level decreased. The risk for high use was the highest among children of mothers and fathers with basic schooling ≤10 years (OR 1.60, 95% CI 1.29-1.98, and OR 1.60, 95% CI 1.34-1.91, respectively). Low income and unemployment were not associated with high antibiotic use. CONCLUSION Socioeconomic factors can only partially explain differences in antibiotic use. Further research is needed to clarify the unequal distribution of antibiotic prescribing and the association between high antibiotic use and low educational level. This would provide valuable information in the planning of strategies to promote rational use of antibiotics among children. KEY POINTS The Capital Region of Denmark has the highest rate of antibiotic prescribing in Denmark. Preschool children are among the age groups with the highest use. Ten percent of the children accounted for 25% of the total antibiotic use. Low parental educational level was associated with increased antibiotic use. Parents' income or employment status was not found to be associated with high antibiotic use.
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Affiliation(s)
- Jette Nygaard Jensen
- a Department of Clinical Microbiology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Lars Bjerrum
- b Section of General Practice and Research Unit for General Practice, Department of Public Health , University of Copenhagen , Copenhagen , Denmark
| | - Jonas Boel
- a Department of Clinical Microbiology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
- c Capital Region Pharmacy , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Jens Otto Jarløv
- a Department of Clinical Microbiology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
| | - Magnus Arpi
- a Department of Clinical Microbiology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark
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20
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Piovani D, Clavenna A, Cartabia M, Bonati M. Antibiotic and anti-asthmatic drug prescriptions in Italy: geographic patterns and socio-economic determinants at the district level. Eur J Clin Pharmacol 2013; 70:331-7. [DOI: 10.1007/s00228-013-1615-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/11/2013] [Indexed: 11/29/2022]
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Baer G, Baumann P, Buettcher M, Heininger U, Berthet G, Schäfer J, Bucher HC, Trachsel D, Schneider J, Gambon M, Reppucci D, Bonhoeffer JM, Stähelin-Massik J, Schuetz P, Mueller B, Szinnai G, Schaad UB, Bonhoeffer J. Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial. PLoS One 2013; 8:e68419. [PMID: 23936304 PMCID: PMC3735552 DOI: 10.1371/journal.pone.0068419] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/25/2013] [Indexed: 01/31/2023] Open
Abstract
Background Antibiotics are overused in children and adolescents with lower respiratory tract infection (LRTI). Serum-procalcitonin (PCT) can be used to guide treatment when bacterial infection is suspected. Its role in pediatric LRTI is unclear. Methods Between 01/2009 and 02/2010 we randomized previously healthy patients 1 month to 18 years old presenting with LRTI to the emergency departments of two pediatric hospitals in Switzerland to receive antibiotics either according to a PCT guidance algorithm established for adult LRTI or standard care clinical guidelines. In intention-to-treat analyses, antibiotic prescribing rate, duration of antibiotic treatment, and number of days with impairment of daily activities within 14 days of randomization were compared between the two groups. Results In total 337 children, mean age 3.8 years (range 0.1–18), were included. Antibiotic prescribing rates were not significantly different in PCT guided patients compared to controls (OR 1.26; 95% CI 0.81, 1.95). Mean duration of antibiotic exposure was reduced from 6.3 to 4.5 days under PCT guidance (−1.8 days; 95% CI −3.1, −0.5; P = 0.039) for all LRTI and from 9.1 to 5.7 days for pneumonia (−3.4 days 95% CI −4.9, −1.7; P<0.001). There was no apparent difference in impairment of daily activities between PCT guided and control patients. Conclusion PCT guidance reduced antibiotic exposure by reducing the duration of antibiotic treatment, while not affecting the antibiotic prescribing rate. The latter may be explained by the low baseline prescribing rate in Switzerland for pediatric LRTI and the choice of an inappropriately low PCT cut-off level for this population. Trial Registration Controlled-Trials.com ISRCTN17057980 ISRCTN17057980
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Affiliation(s)
- Gurli Baer
- Department of Pediatrics, University Basel, Basel, Switzerland
| | | | | | - Ulrich Heininger
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
| | - Gerald Berthet
- Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland
| | - Juliane Schäfer
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Heiner C. Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Daniel Trachsel
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
| | - Jacques Schneider
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
| | - Muriel Gambon
- University Children's Hospital Basel, Basel, Switzerland
| | - Diana Reppucci
- University Children's Hospital Basel, Basel, Switzerland
| | | | | | - Philipp Schuetz
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Beat Mueller
- Department of Internal Medicine, Kantonsspital Aarau, Basel, Switzerland
| | - Gabor Szinnai
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
| | - Urs B. Schaad
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
| | - Jan Bonhoeffer
- Department of Pediatrics, University Basel, Basel, Switzerland
- University Children's Hospital Basel, Basel, Switzerland
- * E-mail:
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Abstract
OBJECTIVES To examine the associations of antibiotic exposures during the first 2 years of life and the development of body mass over the first 7 years of life. DESIGN Longitudinal birth cohort study. SUBJECTS A total of 11 532 children born at 2500 g in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based study of children born in Avon, UK in 1991-1992. MEASUREMENTS Exposures to antibiotics during three different early-life time windows (<6 months, 6-14 months, 15-23 months), and indices of body mass at five time points (6 weeks, 10 months, 20 months, 38 months and 7 years). RESULTS Antibiotic exposure during the earliest time window (<6 months) was consistently associated with increased body mass (+0.105 and +0.083 s.d. unit, increase in weight-for-length Z-scores at 10 and 20 months, P<0.001 and P=0.001, respectively; body mass index (BMI) Z-score at 38 months +0.067 s.d. units, P=0.009; overweight OR 1.22 at 38 months, P=0.029) in multivariable, mixed-effect models controlling for known social and behavioral obesity risk factors. Exposure from 6 to 14 months showed no association with body mass, while exposure from 15 to 23 months was significantly associated with increased BMI Z-score at 7 years (+0.049 s.d. units, P=0.050). Exposures to non-antibiotic medications were not associated with body mass. CONCLUSIONS Exposure to antibiotics during the first 6 months of life is associated with consistent increases in body mass from 10 to 38 months. Exposures later in infancy (6-14 months, 15-23 months) are not consistently associated with increased body mass. Although effects of early exposures are modest at the individual level, they could have substantial consequences for population health. Given the prevalence of antibiotic exposures in infants, and in light of the growing concerns about childhood obesity, further studies are needed to isolate effects and define life-course implications for body mass and cardiovascular risks.
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Affiliation(s)
- L Trasande
- Department of Pediatrics, New York University School of Medicine, New York, NY 10016, USA.
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Panagakou SG, Papaevangelou V, Chadjipanayis A, Syrogiannopoulos GA, Theodoridou M, Hadjichristodoulou CS. Risk factors of antibiotic misuse for upper respiratory tract infections in children: results from a cross-sectional knowledge-attitude-practice study in Greece. ISRN PEDIATRICS 2012; 2012:685302. [PMID: 23209933 PMCID: PMC3503327 DOI: 10.5402/2012/685302] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 06/27/2012] [Indexed: 11/23/2022]
Abstract
Background. Upper respiratory tract infections (URTIs) are common in children. The cause of URTIs is usually viral, but parents' attitudes often contribute to inappropriate prescription of antibiotics, promoting antibiotic resistance. The objective of this study was to identify possible risk factors associated with antibiotic misuse in Greece, a country with high levels of antibiotic use and antibiotic resistance. Methods. A knowledge-attitude-practice (KAP) questionnaire was developed and distributed to Greek parents caring for children who were 5-6 years old, between January and July of the same school year. Results. The sample of the study contained 5312 parents from all geographic areas of Greece. The risk factors of being a father, having low education, having immigrant status, being a single parent, having low income, having <2 or >3 children, living in the islands, and being without experience in recurrent URTIs were significantly associated to inadequate knowledge, inappropriate attitudes, and wrong practices. Conclusions. This study has identified the main groups of parents that should be targeted in future intervention programs.
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Affiliation(s)
- Sotiria G Panagakou
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Thessaly, 41222 Larisa, Greece
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Koller D, Hoffmann F, Maier W, Tholen K, Windt R, Glaeske G. Variation in antibiotic prescriptions: is area deprivation an explanation? Analysis of 1.2 million children in Germany. Infection 2012; 41:121-7. [PMID: 22826031 DOI: 10.1007/s15010-012-0302-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/04/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Inadequate use of antibiotics can lead to problems such as resistance. Overuse is especially a problem for children, since they are more affected by acute (often virus-caused) infections. While the problem has been addressed internationally over the past several years, regional variations in prescriptions are striking. Therefore, the present study aims to analyze regional variations in antibiotic prescription on a district level in Germany and tries to identify reasons for those variations through adding possible influencing factors to the analysis on individual and district levels. METHODS We analyzed 1.2 million children insured in a German health insurance fund. Antibiotic prescriptions were quantified in 2010 and reasons for prescriptions were analyzed in multilevel regressions based on the district of residence, regional deprivation, and age and sex of the child. RESULTS Thirty-six percent of all children aged 0-17 years received an antibiotic prescription in 2010. In the south, prevalences are generally lower, and also to the very north. The highest prevalences are found in the close-to-border districts in the west, as well as in a band throughout the middle of Germany, in rather low population density areas. Regional variation in the prevalence range from 19 to 53 % between districts. Regional deprivation can explain part of this variation. CONCLUSIONS Including area deprivation measures helped identify an influence of especially regional income and occupational deprivation on antibiotic prescriptions for children. Regional analysis such as this can help identify specific regions and groups of persons to address information programs on the risks of preventable antibiotic consumption and alternative treatment methods.
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Affiliation(s)
- D Koller
- Centre for Social Policy Research, University of Bremen, UNICOM-Gebäude, Mary-Somerville-Str. 5, 28359, Bremen, Germany.
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Choi KH, Park SM, Lee JH, Kwon S. Factors affecting the prescribing patterns of antibiotics and injections. J Korean Med Sci 2012; 27:120-7. [PMID: 22323857 PMCID: PMC3271283 DOI: 10.3346/jkms.2012.27.2.120] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 11/25/2011] [Indexed: 11/20/2022] Open
Abstract
There are serious problems concerning the inadequate prescription of antibiotics and overuse of injections in primary care. However, the determinants of prescription patterns in Korea are not well-documented. To examine the area characteristics affecting the prescription of antibiotics and injections in primary care practices in the treatment of respiratory tract infections (RTIs), a nationwide cross-sectional study was performed in all 250 administrative districts of Korea. The outcome was modeled as a binary variable: over-prescription or not compared with the nation-wide average. Over-prescription of antibiotics was associated with the ratio of specialists to general physicians and over-prescription in previous years in the area (adjusted odds ratio [aOR], 4.8; 95% confidence interval [CI] 1.5-14.8; and aOR, 12.0; 95% CI 5.5-25.9, respectively). Over-use of injections was associated with younger population, urban living and the number of hospital beds in the area (aOR, 0.2; 95% CI 0.1-0.4; aOR, 0.3; 95% CI 0.1-0.8; and aOR, 0.4, 95% CI 0.2-0.9; respectively). There were differences in the prescribing patterns in different districts; prescription patterns were affected more by supply factors than by demand factors. Highly competitive medical environment associated with supply factors is a significant determinant of prescription patterns in Korea.
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Affiliation(s)
- Kyung-Hyun Choi
- Department of Health Policy and Management, School of Public Health, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ju-Hyun Lee
- Department of Health Policy and Management, School of Public Health, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soonman Kwon
- Department of Health Policy and Management, School of Public Health, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Keogh C, Motterlini N, Reulbach U, Bennett K, Fahey T. Antibiotic prescribing trends in a paediatric sub-population in Ireland. Pharmacoepidemiol Drug Saf 2012; 21:945-52. [DOI: 10.1002/pds.2346] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 10/10/2011] [Accepted: 11/07/2011] [Indexed: 11/09/2022]
Affiliation(s)
- C Keogh
- HRB Centre for Primary Care Research, Department of General Practice; Royal College of Surgeons in Ireland; Dublin 2; Ireland
| | - N Motterlini
- HRB Centre for Primary Care Research, Department of General Practice; Royal College of Surgeons in Ireland; Dublin 2; Ireland
| | | | | | - T Fahey
- HRB Centre for Primary Care Research, Department of General Practice; Royal College of Surgeons in Ireland; Dublin 2; Ireland
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Ehrenstein V, Antonsen S, Pedersen L. Existing data sources for clinical epidemiology: Aarhus University Prescription Database. Clin Epidemiol 2010; 2:273-9. [PMID: 21152254 PMCID: PMC2998817 DOI: 10.2147/clep.s13458] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Population-based prescription databases in Nordic countries have become a mainstay of epidemiologic research. Denmark has both national and regional population-based prescription databases. Aarhus University Prescription Database collects data on reimbursed medications dispensed at all community pharmacies of the North Denmark Region and the Central Denmark Region. The regions have a combined population of 1.8 million inhabitants, or one-third of the Danish population. Denmark’s primary health care sector, which includes general practitioners, specialists, and dentists, generates about 96% of the prescription sales, most of which are reimbursable and are dispensed by the community pharmacies. The Aarhus University Prescription Database combines the region’s pharmacy records in a single database, maintained and updated for research purposes. Each dispensation record contains patient-, drug-, and prescriber-related data. Dispensation records retain patients’ universal personal identifier, which allows for individual-level linkage to all Danish registries and medical databases. The linked data have many applications in clinical epidemiology, including drug utilization studies, safety monitoring, etiologic research, and validation studies.
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Affiliation(s)
- Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
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Glass SK, Pearl DL, McEwen SA, Finley R. Canadian province-level risk factor analysis of macrolide consumption patterns (2000-2006). J Antimicrob Chemother 2009; 65:148-55. [DOI: 10.1093/jac/dkp391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kristiansson C, Grape M, Gotuzzo E, Samalvides F, Chauca J, Larsson M, Bartoloni A, Pallecchi L, Kronvall G, Petzold M. Socioeconomic factors and antibiotic use in relation to antimicrobial resistance in the Amazonian area of Peru. ACTA ACUST UNITED AC 2009; 41:303-12. [PMID: 19253090 DOI: 10.1080/00365540902783301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Our objective was to correlate antibiotic resistance in gut E. coli flora of children, aged 6-72 months, with use of antibiotics, socioeconomic status (SES) and household characteristics in the urban communities of Yurimaguas and Moyobamba in the Amazonian area of Peru. Caregivers of 1598 children were interviewed using a structured questionnaire in a cross-sectional survey. Faecal samples were collected from the children and the antimicrobial susceptibility of E. coli was analysed by a rapid resistance screening method. Significantly higher odds for resistance were seen for children who had used antibiotics, both during the last 2 weeks and the last 6 months. Children from wealthier families had significantly higher odds for resistance to a number of antibiotics than children from the least wealthy families (Yurimaguas: nalidixic acid, OR = 2.13; ciprofloxacin, OR = 2.09; chloramphenicol, OR = 1.98. Moyobamba: nalidixic acid, OR = 1.59; ciprofloxacin, OR = 1.69). Thus, the children of wealthier families had a significantly increased odds ratio for resistance, also when controlling for the family's antibiotic use. Unknown factors related to socioeconomic status seem to contribute to the results seen in the study area.
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Affiliation(s)
- Charlotte Kristiansson
- Department of Public Health Science, Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
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Antibiotic use among 8-month-old children in Malmö, Sweden--in relation to child characteristics and parental sociodemographic, psychosocial and lifestyle factors. BMC Pediatr 2009; 9:31. [PMID: 19426489 PMCID: PMC2685137 DOI: 10.1186/1471-2431-9-31] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 05/08/2009] [Indexed: 11/10/2022] Open
Abstract
Background In the county of Scania, Sweden, antibiotic use among small children is among the highest in the country. The aim of this study was to investigate the associations between antibiotic use among 8-month-old children in Malmö and characteristics of the child as well as parental sociodemographic characteristics, lifestyle factors, and psychosocial support. Methods The study was a population-based cross-sectional survey. The study population consisted of children who visited the Child Health Care (CHC) centres in Malmö for their 8-month health checkup during 2003–2006 and whose parents answered a self-administered questionnaire (n = 7266 children). The questionnaire was distributed to parents of children registered with the CHC and invited for an 8-month checkup during the study period. Results The odds of using antibiotics increased as parental educational level decreased. Using high educational level as a reference group, low maternal educational level was associated with an increased antibiotic use for the child, odds ratio (OR) = 1.61 (95% CI: 1.34–1.93). Furthermore, children whose parents were born outside Sweden showed higher antibiotic use, OR = 1.43 (95% CI: 1.24–1.65), in comparison with children whose parents were born in Sweden. Exposure to environmental smoking, parental experience of economic stress, and a low level of emotional support increased the odds for antibiotic use. Boys had higher odds of use of antibiotics than girls, OR = 1.40 (95% CI: 1.25–1.57). Having a low birth weight, having an allergy and having siblings also increased the odds for early antibiotic use, while breastfeeding seemed to have a protective role. Conclusion There were clear associations between parental factors such as sociodemographic, psychosocial and lifestyle factors and antibiotic use at this early stage of life. Several characteristics of the child also affected the use of antibiotics.
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Lusini G, Lapi F, Sara B, Vannacci A, Mugelli A, Kragstrup J, Bjerrum L. Antibiotic prescribing in paediatric populations: a comparison between Viareggio, Italy and Funen, Denmark. Eur J Public Health 2009; 19:434-8. [PMID: 19349289 DOI: 10.1093/eurpub/ckp040] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND High rates of antibiotic prescribing in paediatric populations represent a major issue because of the problem of antibiotic resistance. North European countries reported an appropriate use of antibiotics in general population; few studies on this issue have been conducted until now, especially in Italy. Therefore a comparison concerning paediatric antibiotic prescribing rates between an Italian administrative area in Tuscany (Viareggio) and the county of Funen (Denmark) was conducted. METHODS Reimbursement data from 2003 were gathered from the Tuscany Health Authority database and from the database containing pharmacy dispensing data from the Danish Medicines Agency. All data were converted to Defined Daily Doses (DDD) per 1000 inhabitants per day (DDD/TID). Data were broken down by age, identifying four age groups: 0-4, 5-9, 10-14, 15-19 years. RESULTS The overall prescription of antibiotics to paediatric patients from 0 to 19 years of age was higher in Viareggio (67 DDD/TID) than in Funen (35 DDD/TID). In Viareggio amoxicillin and amoxicillin plus enzyme inhibitors ranked in the first two places as the most frequently prescribed antibiotics in the whole population. Cephalosporins were also heavily used in Viareggio with cefaclor being the third most frequently prescribed antibiotic, especially in the 0-4 and 5- to 9-year-old age groups. In Funen, phenoxymethylpenicillin was the most commonly used antibiotic in all age groups, representing almost one-third of prescriptions, followed by amoxicillin. CONCLUSIONS The paediatric antibiotic prescription rate is substantially higher in Viareggio compared with Funen. These data confirm possible overuse and misuse of antibiotics in the Italian paediatric population.
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Affiliation(s)
- Gaia Lusini
- Hospital Pharmacy, ASL 9 Hospital, 58100 Grosseto, Italy
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Rossignoli A, Clavenna A, Bonati M. Antibiotic prescription and prevalence rate in the outpatient paediatric population: analysis of surveys published during 2000–2005. Eur J Clin Pharmacol 2007; 63:1099-106. [PMID: 17891535 DOI: 10.1007/s00228-007-0376-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 08/24/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate antibiotic paediatric consumption data in the community setting using data from studies published between 2000 and 2005 and to compare inter- and intra-country antibiotic prescribing patterns. METHODS A literature search was performed in EMBASE and MEDLINE to identify pharmacoepidemiological studies published between 2000 and 2005. RESULTS Large differences between studies were found, with significant heterogeneity in epidemiological indicators. Only 20 studies reporting comparable drug prescription data were considered in the analysis, all of which were from the USA, Canada, North-Central Europe and Italy. Pre-school children were reported as comprising the most exposed age group to antibiotic therapy (prevalence 72%; prescription rate 2.2 prescriptions/person per year). In the overall child and adolescent population (<or=19 years), prevalence varied from 14 to 57% (mean 34%), and the prescription rate from 0.2 to 1.3 prescriptions/person per year. Relevant inter-country qualitative and quantitative differences in antibiotic prescribing were apparent, although these were observed in only a few countries: prevalence was higher in Italy and Canada (prevalence range 42-57%) and lower in the Netherlands and the United Kingdom (prevalence range 14-21%). Penicillins were the most prescribed antibiotics in all cases (40-70% of antibiotic prescriptions), followed by macrolides (16-45%), while cephalosporins accounted for a large proportion of the prescriptions in Italy (30-40%) and Canada, but were practically absent in North European prescriptions. CONCLUSION Comparative drug utilisation studies on antibiotic use in children are needed, as are improvements in regulatory and educational programmes aimed at limiting the number prescriptions given for antibiotics. Both approaches would address public health problems, such as bacterial resistance and safety and elevated costs, related to the use and misuse of these drugs.
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Affiliation(s)
- Alessandra Rossignoli
- Laboratory for Mother and Child Health, Mario Negri Institute for Pharmacological Research, via G. La Masa 19, 20156 Milan, Italy
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Ciofi degli Atti ML, Massari M, Bella A, Boccia D, Filia A, Salmaso S. Clinical, social and relational determinants of paediatric ambulatory drug prescriptions due to respiratory tract infections in Italy. Eur J Clin Pharmacol 2006; 62:1055-64. [PMID: 17021889 DOI: 10.1007/s00228-006-0198-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 08/04/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Collecting information on patterns of drug prescriptions and on factors influencing prescribing decisions is fundamental for supporting the rational use of drugs. This study was aimed at investigating patterns of drug prescription in paediatric outpatients and at evaluating determinants of prescriptions for respiratory tract infections (RTIs). METHODS We conducted a national cross-sectional survey involving primary care paediatricians and parents. Diagnoses and prescriptions made at each consultation were described. Poisson regression models were used to analyse determinants of drug and antibiotic prescriptions for visits due to RTIs. RESULTS A total of 4,302 physician and parent questionnaires were analysed. These corresponded to 2,151 visits, 792 of which were due to RTIs. Drugs were prescribed in 83.4% of RTI visits, while antibiotics were prescribed in 40.4%. According to paediatricians' perceptions, 84.2% of parents of children with a RTI expected to receive a drug prescription. Paediatricians' perception of parental expectations was the strongest determinant for prescription of drugs and specifically of antibiotics [adjusted relative risk (RR): 1.7 and 3.6, respectively; P < 0.001]. However, in 77.1% of RTI visits, paediatricians judged themselves as not being influenced at all by parents' expectations in their decision to prescribe. CONCLUSIONS This study underscores that relational factors, in particular perceived parental expectations, are one of the leading factors of drug prescriptions in paediatric ambulatory care settings, reinforcing the opinion that communication between physicians and parents can affect prescription patterns.
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Affiliation(s)
- Marta Luisa Ciofi degli Atti
- Reparto Malattie Infettive, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanita', Viale Regina Elena 299, 00161 Rome, Italy.
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Sanz EJ, Hernández MA, Ratchina S, Stratchounsky L, Peiré MA, Lapeyre Mestre M, Horen B, Kriska M, Krajnakova H, Momcheva H, Encheva D, Martínez-Mir I, Palop V. Prescribers' indications for drugs in childhood: a survey of five European countries (Spain, France, Bulgaria, Slovakia and Russia). Acta Paediatr 2005; 94:1784-90. [PMID: 16421040 DOI: 10.1111/j.1651-2227.2005.tb01854.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Indication-based, in comparison to diagnoses-based, drug utilization studies in children are scarce in the literature. AIM To determine the adequacy of the prescriber's indications for specific drug treatments compared to the current literature in five different European countries; and to show the possibilities of performing indication-based drug utilization studies. DESIGN a descriptive, cross-sectional, international study. PATIENTS AND METHODS Randomly selected sample of 12,264 paediatric outpatients seen in consultation rooms attended by paediatricians or general practitioners. Data on patient demographics, diagnoses, and pharmacological treatment, with therapeutic indications for each drug, were collected in pre-designed forms. Diagnoses and indications were coded using the ICD-9 and drugs according to the ATC classifications. RESULTS Indications were registered for every drug prescribed in all locations. Antibiotic indications considered incorrect (common cold, upper respiratory tract infections, viral infections, general symptoms or "not specified") accounted from 24.1% of the total antibiotics prescribed in Tenerife to 67.4% in Slovakia. Incorrect indication of first-choice antibiotics prescribed in acute otitis media and tonsillitis ranged from 28.9% of total antibiotics use in Russia to 75.4% in Tenerife. Correct antibiotic indications ranged from 23.4% of total antibiotics used in Slovakia to 65.7% in Tenerife. Aspirin use in febrile viral conditions was detected mainly in Toulouse and Russia. CONCLUSION The main areas for improvement detected were high use of mucolytics, prescription of aspirin in potential or established viral infections, overuse of antibiotics and identification of specific patterns of incorrect antibiotic prescription and clinical entities associated with each location.
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Affiliation(s)
- Emilio J Sanz
- Department of Clinical Pharmacology, School of Medicine, University of La Laguna, La Laguna, Tenerife, Spain.
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Dubois L, Girard M. Breast-feeding, day-care attendance and the frequency of antibiotic treatments from 1.5 to 5 years: a population-based longitudinal study in Canada. Soc Sci Med 2005; 60:2035-44. [PMID: 15743652 DOI: 10.1016/j.socscimed.2004.08.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2003] [Accepted: 08/25/2004] [Indexed: 11/30/2022]
Abstract
This paper aims to study, at the population level, the protective role of breast-feeding on child health and its relation to day-care attendance during the first 5 years of life. The analysis, done on a national sample of children, uses antibiotic treatments as a general measure of health. It takes into account mother's education level, family poverty level, mother's smoking status during pregnancy and after birth, mother's age, sex, gestation duration, and birth rank. The analyses were performed using data from the Longitudinal Study of Child Development in Quebec (LSCDQ), conducted by Santé Québec, a division of the Institut de la Statistique du Québec (ISQ). The study was based on face-to-face interviews and included a set of questionnaires addressed to the children's mothers and fathers. A total of 1841 were included in the sample analyzed. Detailed information on breast-feeding and complementary feeding was collected at 5 and 17 months through face-to-face interviews with the most knowledgeable person, generally the mother. From this information, it has been possible to estimate breast-feeding duration and exclusivity. Our results indicate that the positive effects of breast-feeding on health persist up to the second year of life, even in the presence of day-care attendance. The analyses indicate that breast-feeding reduced the number of antibiotic treatments given to children entering day care before 2.5 years of age. The study also indicates that the more-at-risk children could be protected by breast-feeding and by being taken care of in a familial setting, especially before 2.5 years of age. Mother's education, family poverty level, and other social inequality indicators did not play a role in the frequency of antibiotic treatments. Over the long term, it will be important to continue to monitor the health of children and to implement public health interventions aimed at reducing health problems among children of preschool age.
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Affiliation(s)
- Lise Dubois
- Faculty of Medicine, Department of Epidemiology and Community Medicine, Institute of Population Health, University of Ottawa, 1 Stewart Street, office 303, Ottawa, Ont., Canada, K1N 6N5.
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Kozyrskyj AL, Dahl ME, Chateau DG, Mazowita GB, Klassen TP, Law BJ. Evidence-based prescribing of antibiotics for children: role of socioeconomic status and physician characteristics. CMAJ 2004; 171:139-45. [PMID: 15262882 PMCID: PMC450362 DOI: 10.1503/cmaj.1031629] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Evidence-based guidelines for antibiotic use are well established, but nonadherence to these guidelines continues. This study was undertaken to determine child, household and physician factors predictive of nonadherence to evidence-based antibiotic prescribing in children. METHODS The prescription and health care records of 20 000 Manitoba children were assessed for 2 criteria of nonadherence to evidence-based antibiotic prescribing during the period from fiscal year 1996 (April 1996 to March 1997) to fiscal year 2000: receipt of an antibiotic for a viral respiratory tract infection (VRTI) and initial use of a second-line agent for acute otitis media, pharyngitis, pneumonia, urinary tract infection or cellulitis. The likelihood of nonadherence to evidence-based prescribing, according to child demographic characteristics, physician factors (specialty and place of training) and household income, was determined from hierarchical linear modelling. Child visits were nested within physicians, and the most parsimonious model was selected at p < 0.05. RESULTS During the study period, 45% of physician visits for VRTI resulted in an antibiotic prescription, and 20% of antibiotic prescriptions were for second-line antibiotics. Relative to general practitioners, the odds ratio for antibiotic prescription for a VRTI was 0.51 (95% confidence interval [CI] 0.42-0.62) for pediatricians and 1.58 (95% CI 1.03-2.42) for other specialists. The likelihood that an antibiotic would be prescribed for a VRTI was 0.99 for each successive 10,000 Canadian dollars increase in household income. Pediatricians and other specialists were more likely than general practitioners to prescribe second-line antibiotics for initial therapy. Both criteria for nonadherence to evidence-based prescribing were 40% less likely among physicians trained in Canada or the United States than among physicians trained elsewhere. INTERPRETATION The links that we identified between nonadherence to evidence-based antibiotic prescribing in children and physician specialty and location of training suggest opportunities for intervention. The independent effect of household income indicates that parents also have an important role.
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Affiliation(s)
- Anita L Kozyrskyj
- Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg.
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Arias Alvarez MA, Sánchez Bayle M, Gancedo García C, Martín Martín R, Estepa Soto MR, Díaz Martínez ME. Nivel socioeconómico y consumo de recursos sanitarios en atención primaria. An Pediatr (Barc) 2004; 61:292-7. [PMID: 15456583 DOI: 10.1016/s1695-4033(04)78391-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To determine the influence of socioeconomic status on healthcare demand and resource consumption in our population. PATIENTS AND METHODS We performed a cross sectional, retrospective study of socioeconomic status and healthcare and pharmaceutical consumption in randomly selected patients from five primary care pediatric clinics in Madrid. The chi-square test was used to compare percentages. For the remaining analyses, nonparametric tests were used after confirming that the data followed non-normal distribution. RESULTS We compared 684 questionnaires. Patients in the most disadvantaged socioeconomic levels consumed a greater number of drugs than those in more privileged levels (mean 0.79 vs. 0.47, p = 0.04). The mean pharmacological expenditure was also higher in the lowest socioeconomic levels than in the highest levels (5.28 Euros vs. 2.21 Euros, respectively; p = 0.001). No significant differences were found among socioeconomic levels in the number of consultations or diagnostic tests requested. The number of consultations was higher in younger patients (p < 0.001) or in those with chronic diseases (p = 0.001). Drug consumption was increased in the most disadvantaged levels (p = 0.002) and in patients with chronic diseases (p < 0.001). Lastly, pharmacological expenditure expressed in Euros was also higher in the lowest socioeconomic levels (p = 0.001) and in patients with chronic diseases (p < 0.001) but was lower if one of the parents was a foreigner (p = 0.031). CONCLUSIONS We found a relationship between socioeconomic level and drug consumption and its attributable cost. These data should be confirmed by broader studies.
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