Association between National Treatment Guidelines for Upper Respiratory Tract Infections and Outpatient Pediatric Antibiotic Use in France: An Interrupted Time-Series Analysis

J Pediatr. 2020 Jan;216:88-94.e4. doi: 10.1016/j.jpeds.2019.09.017. Epub 2019 Oct 11.


Objective: To test whether updated clinical practice guidelines for managing upper respiratory tract infections released in France in November 2011 were associated with changes in national outpatient pediatric antibiotic use.

Study design: We performed an interrupted time-series analysis using national antibiotic dispensation data in French children from January 2009 to December 2017 (IQVIA Suivi de la Dispensation Médicale database). We described the overall evolution of antibiotic prescription rates and modeled the changes in the proportion of amoxicillin and the proportion of broad-spectrum antibiotics following the guidelines in 2 age groups (0-5 and 6-14 years old).

Results: We analyzed 123 million pediatric antibiotic prescriptions. The most commonly prescribed individual antibiotic agent was amoxicillin (37.7%). Over the study period, the annual antibiotic prescription rate decreased by 33.1% (from 1387 to 928 per 1000 pediatric inhabitants per year), consistently across age groups and major antibiotic agents except for amoxicillin (+14.4%). After the release of the guidelines, we observed a gradual increase in the proportion of amoxicillin (relative change 5 years postintervention of +64.3% [95% CI 51.6-80.1] and +28.4% [21.1-36.2] for children 0-5 and 6-14 years, respectively) concomitantly with a gradual decrease in the proportion of broad-spectrum antibiotics (relative change 5 years postintervention of -26.1% [-29.3, -23.7] and -19.8% [-22.1, -16.0] for children 0-5 and 6-14 years old, respectively).

Conclusions: The 2011 guidelines for upper respiratory tract infections preceded changes in outpatient pediatric antibiotic use at the national level, with a replacement of broad-spectrum antibiotics by amoxicillin.

Keywords: autoregressive integrated moving average modeling; clinical practice guidelines; interrupted time–series analysis; pediatric antibiotic use; respiratory tract infections.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Amoxicillin / therapeutic use*
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship
  • Child
  • Child, Preschool
  • Drug Prescriptions / statistics & numerical data*
  • France / epidemiology
  • Guideline Adherence / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Interrupted Time Series Analysis
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Respiratory Tract Infections / drug therapy*
  • Respiratory Tract Infections / epidemiology


  • Anti-Bacterial Agents
  • Amoxicillin