Case study

Antibiotics and children – The Netherlands

There are several difficulties in antibiotic decision-making in children with RTIs. This is due to more difficulties in the assessment of disease severity, the possible rapid progression of severity and fever, and the less clear guidelines for antibiotic treatment of children. Dr van der Velden stated that the communication between the doctor/pharmacist and the parent/child could be complicated. HCPs may speak directly to the parent and it is often the parent’s worries and expectations that are then being addressed.

“Antibiotic decision making in children is more complicated than for adults“ - Dr Van der Velden

Frequency of antibiotic prescribing for ear infections and URTIs decline with age, for tonsillitis and urinary tract infections (UTIs) increase with age, and for pneumonia and fever rates remain steady. The decision to prescribe antibiotics is up to the physician and depends on infection severity and the presence of fever.

Dr van der Velden said that for children, an antibiotic is prescribed in 32% of consultations for an RTI in the Netherlands, with 31% of these considered to be over-prescribing. Inappropriate prescribing is related to a diagnosis of bronchitis or tonsillitis, presence of fever and GPs perception of the parents wish for antibiotics.

“31% of antibiotic prescriptions for RTI treatment in children are inappropriate“ - Dr Van der Velden

In the Netherlands, the RAAK (rational antibiotic use for children) intervention study is being performed to investigate the effects of an online education for GPs and informative material for parents on the use of antibiotics in children at 40 primary care practices. Baseline measurements are to be observed and the intervention will occur in September 2014. Registration data, patient questionnaires and pharmacy data will then be used to measure outcomes. Dr van der Velden described a low antibiotic prescribing rate for children in the Netherlands with the majority prescribed for RTIs and ear infections. The youngest age group, 0 to 4 years, had the highest prevalence of antibiotic prescriptions, followed by 5–12 years and 13–18 years. Amoxicillin was the most commonly prescribed antibiotic.

Communication and antibiotic use – Germany

Prof. Altiner shared information on a study that has begun in Germany which aims to show the effect of an intervention to educate HCPs in appropriate antibiotic use. Overall, 75 paediatricians and 90 GPs are included and split into three groups: a control group, a communication training group and a communication training plus POCD group.

Baseline data is being gathered, an intervention to include webinars and patient education will then occur with and without POCD, and the data evaluated. Videos have been developed to train HCPs and objection handling and treatment algorithms have been designed.