Nationwide health data from Norway reveal significant progress in reducing antibiotic prescriptions for childhood respiratory infections, while highlighting persistent challenges in managing ear infections. This development follows a comprehensive study published in JAC Antimicrobial Resistance, examining trends in antibiotic use among preschool children.
The study, which analyzed data from 2012 to 2019, found a marked decrease in antibiotic prescriptions for respiratory tract infections (RTIs). Despite this progress, researchers emphasize the potential for further improvements in adhering to treatment guidelines and antibiotic stewardship, even in a country known for its low prescribing rates.
Understanding the Importance of Reducing Antibiotic Use
Antimicrobial resistance (AMR) remains a critical global health threat, largely driven by the overuse and misuse of antibiotics. There is a clear association between the volume of antibiotic consumption in a population and the emergence of resistant bacteria. Although Norway is among the countries with relatively low antibiotic prescribing rates, national health authorities recognize the need for continued reductions.
Norway has implemented several national strategies to combat AMR, including guidelines recommending narrow-spectrum penicillins as the first-line treatment for RTIs. Preschool children frequently experience RTIs, most of which are viral and self-limiting. However, previous studies have shown that antibiotics are often prescribed unnecessarily in this age group.
Nationwide Data Provides Insight
The recent study utilized data from four Norwegian health registries, capturing all general practitioner consultations, hospital admissions, demographic data, and dispensed prescription medications. This comprehensive data allowed researchers to assess trends in RTI episodes, antibiotic prescribing rates, and antibiotic selection among preschool-aged children before the COVID-19 pandemic.
The study population included children under five years who had contact with general practice for RTIs during the study period. Infants under one year and children admitted to hospital or specialist care on the same day as their first consultation were excluded. RTI episodes were defined by grouping healthcare contacts within 30 days of an initial RTI diagnosis, with a maximum follow-up of 90 days per episode.
Over the study period, more than 3.1 million general practice contacts for RTIs were recorded, corresponding to just over 2 million RTI episodes.
Persistent Challenges with Otitis and URTI
The study revealed that otitis and upper respiratory tract infections (URTI) dominate the remaining antibiotic exposure. While overall RTI episode rates declined by 17% from 2012 to 2019, otitis and URTI accounted for over half of all antibiotic prescriptions. Despite a general decline in prescription rates, otitis, tonsillitis, and pneumonia remained associated with high antibiotic use.
Importantly, there was a shift towards guideline-recommended treatment, with an increased use of phenoxymethylpenicillin and declining macrolide use. This suggests a partial improvement in alignment with treatment guidelines, reflecting more cautious prescribing practices and changes in parental health-seeking behavior.
Future Directions and Implications
The reduction in antibiotic use among preschool children was driven by fewer RTI episodes, lower prescribing rates per episode, and improved adherence to treatment guidelines. However, the study’s observational design means causal relationships could not be directly assessed. Persistent high antibiotic prescribing for otitis may indicate non-adherence to guidelines or a shift towards more severe cases presenting in primary care.
The study’s use of high-quality nationwide registry data is a significant strength, covering the entire population over several years. Nevertheless, reliance on administrative data limited insight into clinical decision-making, disease severity, and diagnostic accuracy. Infection outbreaks and seasonal variations also potentially influenced the findings.
Overall, the study demonstrates that further reductions in antibiotic use are achievable even in low-prescribing settings. Targeted stewardship efforts, particularly for otitis and other self-limiting RTIs, remain an important focus for future interventions to combat antimicrobial resistance.
As Norway continues to refine its strategies to combat AMR, the findings underscore the importance of ongoing efforts to enhance antibiotic stewardship and adherence to clinical guidelines, ensuring that antibiotic use is both judicious and effective.
