Antibiotic Use in Children - A Cross-National Analysis of 6 Countries

J Pediatr. 2017 Mar;182:239-244.e1. doi: 10.1016/j.jpeds.2016.11.027. Epub 2016 Dec 21.


Objectives: To describe the rates of pediatric antibiotic use across 6 countries on 3 continents.

Study design: Cross-national analysis of 7 pediatric cohorts in 6 countries (Germany, Italy, South Korea, Norway, Spain, and the US) was performed for 2008-2012. Antibiotic dispensings were identified and grouped into subclasses. We calculated the rates of antimicrobial prescriptions per person-year specific to each age group, comparing the rates across different countries.

Results: A total of 74 744 302 person-years from all participating centers were included in this analysis. Infants in South Korea had the highest rate of antimicrobial consumption, with 3.41 prescribed courses per child-year during the first 2 years of life. This compares with 1.6 in Lazio, Italy; 1.4 in Pedianet, Italy; 1.5 in Spain; 1.1 in the US; 1.0 in Germany; and 0.5 courses per child-year in Norway. Of antimicrobial prescriptions written in Norway, 64.8% were for first-line penicillins, compared with 38.2% in Germany, 31.8% in the US, 27.7% in Spain, 25.1% in the Italian Pedianet population, 9.8% in South Korea, and 8% in the Italian Lazio population.

Conclusions: We found substantial differences of up to 7.5-fold in pediatric antimicrobial use across several industrialized countries from Europe, Asia, and North America. These data reinforce the need to develop strategies to decrease the unnecessary use of antimicrobial agents.

Keywords: antibiotics; children; cross-national analysis.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Age Factors
  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / drug therapy*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cross-Sectional Studies
  • Drug Utilization / statistics & numerical data*
  • Female
  • Germany
  • Humans
  • Incidence
  • Infant
  • Internationality
  • Italy
  • Male
  • Norway
  • Republic of Korea
  • Retrospective Studies
  • Spain
  • United States


  • Anti-Bacterial Agents