Development of antibiotic prescriptions in outpatient pediatric care in Bielefeld 2015–2018: Use of statutory healthcare routine data as basis for antibiotic stewardship in outpatient care

Abstract

Background: In the containment of antibacterial drug resistance, the rational use of antibiotics, usually addressed as antimicrobial stewardship (or antibiotic stewardship, ABS), plays a pivotal role. For the targeted allocation of ABS measures, a differentiated analysis of antibiotic prescriptions is necessary. In the Bielefeld ABS project AnTiB, originating from the outpatient pediatric sector, a methodology for a local and individual physician-oriented prescription analysis was developed and implemented. Methods: In a cross-sectional study, pharmacy billing data of the years 2015–2018, from prescriptions in outpatient pediatric care, available through the Association of the Statutory Health Insurance Physicians, were analyzed. Included were all children and adolescents up to 18 years of age. Results: During the study period 28 pediatricians issued altogether 28,677 antibiotic prescriptions for 20,868 individual patients. The median patient age was 5.0 years (25th and 75th percentile 2.6 years and 8.8 years, respectively) with almost equal numbers of girls and boys. Of the prescriptions 40% were related to the age group between 2 and <6 years. The prescriptions were inhomogeneously distributed over time, with weekly and seasonal fluctuations. There was a high interindividual variance between different pediatricians as well as a high regional variation between districts within the region of Westfalen-Lippe. Conclusion: The field-tested methodology of a differentiated local monitoring of antibiotic use by pediatricians active in outpatient care can be transferred to other medical disciplines and might contribute to generate a database for comprehensive but targeted ABS approaches in the outpatient sector. The causes for the relatively inconsistent antibiotic prescription patterns between individual pediatricians are manifold but local antibiotic prescription cultures may play a relevant role. These cultures should be identified and modified in the sense of ABS.