Patient and prescriber determinants for the choice between amoxicillin and broader-spectrum antibiotics: A nationwide prescription-level analysis

Abstract

Objectives: Bacterial resistance to antibiotics, driven by antibiotic consumption, imposes a major threat to the effective treatment of bacterial infections. In addition to reducing the amount of antibiotics prescribed, avoiding broad-spectrum antibiotics could extend the lifetime of the current arsenal of antibiotic substances. Therefore,we documented prescriber and patient characteristics associated with the choice between amoxicillin and broaderspectrum alternatives (co-amoxiclav or moxifloxacin) in recent years in Belgium. Methods: Complete reimbursementclaims data(2002-09) for antibiotic prescriptions in outpatient care, including patient and prescriber characteristics, were collected for both young children (1-5 years) and the adult population (30-60 years). A backwards selection procedure within generalized estimating equations retained the most relevant determinants.Results: The age, gender and social category of the patient were found to be predictive of the extent to which amoxicillin was prescribed instead of the broader-spectrum alternatives, with female patients generally taking a higher proportion of amoxicillin than male patients. The age category of 40-44-year-old prescribers exhibited a preference for broad-spectrum antibiotics compared with both younger and older age groups. Significant interactions between the regionandthe prescriber's qualification (general practitioner or paediatrician) onthe choice of antibiotic for children were found. Conclusions: Patient (age, gender and social category) and prescriber characteristics (age, gender, region and qualification) had an influence on whether amoxicillin or the alternative broad-spectrum antibiotics were prescribed. These findings should help policymakers to better target future campaignsto promoteprudent prescribing of antibiotics. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.