Use of amoxicillin, amoxicillin/clavulanate and cefaclor in the Italian pediatric population

Antibiotics are the most prescribed drugs in children, often administered without any specific diagnosis. In Italy, Family Pediatricians prescribe antibiotics more frequently than in other Europe countries, the commonest being amoxicillin, amoxicillin/clavulanate and cefaclor. We conducted a retrospective cohort study of children up to 12 years old, included in the database Pedianet, who received at least one prescription of amoxicillin, amoxicillin/clavulanate or cefaclor during the period 1 st January 2003 to 30 th June 2007. 335,352 antibiotics prescriptions in 110,747 children were included in the study. There were 168,458 prescriptions of amoxicillin, amoxicillin/clavulanate or cefaclor, amounting to 50.2% of antibiotic prescriptions. The main indication was unspecified-upper respiratory tract infection (26.5%). Overall, amoxicillin/clavulanate was the most commonly prescribed antibiotic in older children, while amoxicillin was the most prescribed in younger patients. Amoxicillin was the most prescribed antibiotic in all age groups (p < 0.0001) for upper respiratory tract infections, otitis media and acute bronchitis. A therapeutic switch occurred in 0.6% of cases, and was most frequent in pneumonia. This was a retrospective study carried out using software designed for the routine practice and not for specific studies; therefore several limitations on the data interpretation need to be considered especially on the diagnosis. However, the study shows that antibiotic consumption in the Italian pediatric population exceeds the European average, with three beta-lactam drugs accounting for over half of all antibiotic prescriptions.