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A Comparison of Antibiotic Use in Children Between Canada and Denmark

Associate Professor, Faculty of Pharmaceutical Sciences, University of British Columbia; Director, Vaccine and Pharmacy Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada

Dominique L Monnet, PharmD PhD

Head, Antimicrobial Resistance Surveillance Unit, National Center for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark

David M Patrick, MD MHSc FRCPC

Director, Communicable Disease Epidemiology, British Columbia Centre for Disease Control; Associate Professor, Health Care and Epidemiology, University of British Columbia

Mei Chong, MSc

Surveillance Analyst, Communicable Disease Epidemiology, British Columbia Centre for Disease Control

Christian T Brandt, MD

Researcher, Antimicrobial Resistance Surveillance Unit, National Center for Antimicrobials and Infection Control, Statens Serum Institut

Meghan Winters, BSc

Masters Student, Health Care and Epidemiology, University of British Columbia

Margit S Kaltoft, MD PhD

Head, National Streptococcus Reference Laboratory, Statens Serum Institut

Gregory J Tyrrell, PhD FCCM

Director, National Centre for Streptococcus; Associate Professor, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada

Marguerite Lovgren, MLT ART

Technical Supervisor, National Centre for Streptococcus

William R Bowie, MD FRCPC

Professor, University of British Columbia; Division of Infectious Diseases, Department of Medicine, Vancouver Hospital and Health Sciences Centre, Vancouver

Reprints: Dr. Marra, Vaccine and Pharmacy Services, BC Centre for Disease Control, 655 W 12th Ave., Vancouver, BC, V5Z 4R4, Canada, fax 604/775-2718, fawziah.marra{at}bccdc.ca

BACKGROUND: High rates of antibiotic prescribing in children lead to antibiotic resistance in the community. Surveillance on utilization rates and comparisons with other jurisdictions are methods for benchmarking. Surveillance on antibiotic use is well established in Europe, including Denmark, but until recently, similar data from Canada were lacking.

OBJECTIVE: To compare pediatric antibiotic prescribing rates in British Columbia, Canada, with those in Denmark.

METHODS: Population-based data on antibiotic prescriptions from British Columbia and Denmark were obtained from 1999 to 2003 for children less than 15 years of age. Annual trends in prescription rates per 1000 children were analyzed by using generalized linear models for all children less than 15 years of age; they were stratified by age group (0–4, 5–9, 10–14 y) for all antibiotics. Class-specific trends were also evaluated for penicillins, cephalosporins, macrolides, sulfonamides and trimethoprim, tetracyclines, and fluoroquinolones.

RESULTS: From 1999 to 2003, the overall British Columbia prescription rate was significantly higher than that of Denmark (p < 0.0001) at all age stratifications. In 2003, the British Columbia prescription rate was twice that of Denmark, at 608 versus 385 prescriptions per 1000 children, respectively. In both jurisdictions, the majority of antibiotics used were penicillins (Anatomical Therapeutic Chemical class J01C). However, in British Columbia, most penicillins used were extended-spectrum (83% in 2003); in Denmark, 34% of penicillins used in 2003 were extended-spectrum and 56% were ß-lactamase sensitive. In British Columbia, use of penicillins (–4.5%), cephalosporins (–5.5%), trimethoprim/sulfamethoxazole (–36%), and tetracycline (–1.6%) decreased over time, whereas in Denmark, use of penicillins increased by 11% over time and non-penicillin antibiotics remained stable. A significant increase in macrolide consumption was seen in British Columbia due to use of clarithromycin and azithromycin; in contrast, macrolide consumption declined in Denmark.

CONCLUSIONS: Compared with Denmark, the antibiotic prescription rate for children is substantially higher in British Columbia. In addition, there has been a significant increase in the use of macrolides, especially the second-generation agents, in British Columbia compared with the use in Denmark. Further studies are required to delineate reasons for antibiotic prescribing patterns in these 2 jurisdictions.

Key Words: antibiotic prescribing, pediatrics, resistance, Streptococcus pneumoniae

Published Online, March 20, 2007. www.theannals.com, DOI 10.1345/aph.1H293

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