Title: Clinical impact of reducing antibiotic prescribing in children
1Clinical impact of reducing antibiotic
prescribing in children
- Dr Mike Sharland
- Paediatric Infectious Diseases Unit,
- St Georges Hospital
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3PPA 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
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6.
7Variation Between Strategic Health Authorities in
Prescribing of Phenoxymethylpenicillin Paediatric
Preparations (January 2002-December 2002)
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13Changes 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
14Time 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
15Change in antibiotic prescribing to children by
age expressed as a percentage of all prescribing
of all prescribing to same age group
16Hospital 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