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Clinical impact of reducing antibiotic prescribing in children

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Clinical impact URT complications mastoiditis, quinsy and rheumatic fever ... Hospital admission rate/100000 for quinsy or rheumatic fever in children age 0 ... – PowerPoint PPT presentation

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Title: Clinical impact of reducing antibiotic prescribing in children


1
Clinical impact of reducing antibiotic
prescribing in children
  • Dr Mike Sharland
  • Paediatric Infectious Diseases Unit,
  • St Georges Hospital

2
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3
PPA paediatric data
  • No age data available
  • Mainly oral liquids including granules for
    reconstitution
  • Low strength tablets and sachets e.g. amoxicillin
    125mg
  • Other products which include paediatric in title
  • Validated by random sampling

4
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6
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7
Variation Between Strategic Health Authorities in
Prescribing of Phenoxymethylpenicillin Paediatric
Preparations (January 2002-December 2002)
8
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13
Changes in prescribing
  • Change in clinical general practice prescribing
    advisors ?
  • Advice DH, Guidelines?
  • Changes in respiratory illness?
  • Clinical impact URT complications
    mastoiditis, quinsy and rheumatic fever

14
Time trend in prescribing of antibiotics to
children in general practice expressed as a
percentage of prescribing in 1993 pharmacy data
from Prescription Pricing Authority (PPA) and
general practice prescribing data from IMS
Disease Analyzer Mediplus

of prescribing in 1993
15
Change in antibiotic prescribing to children by
age expressed as a percentage of all prescribing
of all prescribing to same age group
16
Hospital admission rate/100000 for quinsy or
rheumatic fever in children age 0-14 years
(Hospital Episode Statistics for England
1993-2002)
17
Age specific hospital admission rate/100000 for
mastoiditis or simple mastoidectomy in children
age 0-14 years (Hospital Episode Statistics for
England 1993-2002)
18
? A real problem
  • Consult rate for earache in GP 4800/100,000
    children/year
  • NNT around 5000 reduction in prescriptions 5m
    with 100 additional cases of mastoiditis
  • Relationship between mastoiditis, otitis media
    and antibiotic prescribing unclear

19
? How low can we go
  • UK now around 500 antibiotic prescriptions/1000
    children/year
  • USA 1100 Holland 150
  • Need improved information on identifying those at
    risk of complications from OM etc
  • Enhanced vaccination strategies influenza,
    prevenar
  • Long term linked paediatric clinical,
    microbiological and prescribing surveillance
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