Temporal trend in paediatric infections in Denmark.

AIM: To study temporal trends in the incidence of hospitalisations due to infection in children in Denmark. METHODS: A national register based cohort of 1 892 711 Danish children aged 0-5 years were studied from 1980 to 2001. Child and family characteristics were identified in the Danish Civil Registration System; hospitalisations were identified in the Danish National Patient Registry. Annual incidence rates were estimated using log-linear Poisson regression. RESULTS: During the studied period, the incidence of hospitalisations from infection increased by 62% in 0-5 year old children. The increase was mainly due to a sevenfold increase in the incidence of infections leading to short term hospitalisation in children aged 0-1 years. Since the increase in incidence was contrasted with a decrease in duration of hospitalisation, no further strain was put on the health services in Denmark. CONCLUSION: During the last two decades, the incidence of short term hospitalisations due to infections increased markedly among the youngest children. However, the strain on the health services remained constant. The observed increase in the incidence of short term hospitalisations among the youngest children may reflect changes in hospitalisation practices and utilisation, rather than an increase in incidence of infections.

Psychosocial distress during pregnancy and the risk of infantile colic: a follow-up study.

AIM: To examine the association between psychosocial exposures during pregnancy and the risk of infantile colic. METHODS: The study included 378 infants and was conducted as a substudy of the Danish National Birth Cohort from 1997 to 1999, with prenatal data collected twice during pregnancy. A diary with a record for postpartum weeks 4-8 was used to quantify the amount of the infants' crying and fussing. RESULTS: The cumulative incidence proportion of infantile colic was 8.2%. A threefold increased risk of infantile colic (OR = 3.7; 95% CI: 1.1-13.2) was found for mothers who reported distress during pregnancy. Close to a twofold increased risk of IC was found for the women who scored higher than 8 on the psychological distress scale (adjusted OR = 1.9; 95% CI: 0.5-7.2). CONCLUSION: The results indicate that general distress during pregnancy influences the risk of infantile colic. Whether or not this relationship is causal requires further investigations.

Do pregnant women report use of dispensed medications?

Surveillance of drug safety in pregnancy often draws on administrative prescription registries. Noncompliance in the use of prescribed medication may be frequent among pregnant women owing to their fear of fetotoxic side effects. To estimate compliance in the use of prescription drugs dispensed during pregnancy, we compared prescription data from the North Jutland Prescription Database with information on drug use provided by pregnant women to the Danish National Birth Cohort (DNBC), which is a health interview survey. We used the North Jutland Prescription Database to identify all prescription drugs dispensed during pregnancy for the 2,041 women who were enrolled in the DNBC in the County of North Jutland, Denmark. Compliance was defined as the probability of reporting drug use in DNBC after purchasing a dispensed prescription drug. The overall compliance to drugs purchased within 120 days before the interview was 43% (95% confidence interval = 40-46). Drugs used for treating chronic diseases, for example, beta-blockers, insulin, thyroid hormones, and diuretic and antiepileptic drugs, were always reported to be used, but compliance was low for drugs used for local or short-term treatment such as antihistamines, antibiotics, antacids, nonsteroid anti-inflammatory drugs, and gynecologic drugs. Thus, for the latter drug groups the prescription database may provide an incomplete identification of exposure. Neither data source is unbiased regarding actual drug intake. Nevertheless, our results indicate that for some drug groups risk assessment studies based on prescription data may produce false negative results as a result of noncompliance.

A population-based prescription study of asthma drugs during pregnancy: changing the intensity of asthma therapy and perinatal outcomes.

BACKGROUND: Among the goals of gestational asthma, therapy is optimisation of pulmonary function. According to the US Food and Drug Administration, no asthma drugs can be considered 'safe' during pregnancy. Fear of adverse fetal effects may thus lead to restrictive use of asthma drugs during pregnancy, and no population-based studies concerning gestational asthma therapy exist. OBJECTIVES: To examine whether asthma drugs or changing intensity of asthma therapy during pregnancy was associated with deviations from expected values of gestational age, birth weight, length at birth, or malformations. METHODS: The Birth Registry was used to identify all 15,756 primiparous women who gave birth in the County of North Jutland between 1991 and 1996. According to the North Jutland Prescription Database, 303 of these women received prescriptions for asthma drugs during pregnancy. Women who did not purchase any prescription drugs during pregnancy constituted the reference group. CONCLUSION: Women who received prescriptions for asthma drugs during pregnancy gave birth to infants with birth weight and length at birth within the expected limits. Reducing intensity of asthma treatment during pregnancy was associated with lower birth weight and length at birth. This may indicate that pregnant women chose to discontinue therapy although their disease severity justifies continuation of treatment. However, analyses did not take into account important clinical variables, and results could also be due to confounding factors or chance.

Influence of day care attendance on the use of systemic antibiotics in 0- to 2-year-old children.

OBJECTIVE: To examine the association between time spent in different public day care settings and prescription of systemic antibiotics. Design. Population-based cohort study of 5035 Danish children born in 1997 followed from birth to June 30, 1999. METHODS: The study was performed by the linkage of records drawn from administrative registries. Exposure was the total time spent in a day care home or day care center. Outcome was the first prescription of a systemic antibiotic. Possible perinatal and sociodemographic confounding factors were considered by statistical analysis. RESULTS: During the first year of life, 39.8% of the girls and 51.1% of the boys received at least 1 antibiotic prescription drug. Enrollment in a day care setting doubled a child's risk of receiving a prescription drug (adjusted relative risk in day care home 1.9, 95% confidence interval: 1.7-2.0; adjusted relative risk in day care center 2.0, 95% confidence interval: 1.7-2.3). Only age confounded the analyses. Age >1 year at the starting time in day care reduced the risk of receiving antibiotic prescriptions during the first 3 months after enrollment. CONCLUSIONS: Enrollment in public day care facilities raised the risk of receiving an antibiotic prescription drug to the same extent in day care homes as well as in day care centers, so we cannot recommend one facility over the other based on the present study. Children <1 year old at enrollment were most at risk, suggesting that extension of parental leave may reduce the use of antibiotics.

Effect of diuretics on fetal growth: A drug effect or confounding by indication? Pooled Danish and Scottish cohort data.

AIMS: The diabetogenic effect of diuretics, as well as the indication for prescribing them, may impact on fetal growth. We analysed whether the purchase of prescription drugs for diuretics during pregnancy was associated with measures of fetal growth. METHODS: During 1991-98 all women who purchased prescription drugs for diuretics during pregnancy were identified in the Northern Jutland Prescription Database (NJDP), Denmark, and in the Medicines Monitoring Unit's Database (MEMO), Scotland. Information on birth weight and gestational age was obtained from the Danish Birth Registry, the Danish Hospital Discharge Registry and the Scottish Tayside Neonatal Database. Information on diabetes, hypertension and prepregnancy weight were obtained by hospital record review in a sample of women in the Danish cohort. Women who did not purchase prescription diuretics during pregnancy were used as a reference group in both cohorts. RESULTS: Danish women who purchased prescription loop diuretics during pregnancy gave birth to infants with higher birth weights than women who did not use diuretics; mean difference 104.7 g (95% CI; 2.6, 206.9). However, the high prevalence of diabetes (10.3%) among Danish women who purchased prescription loop diuretics during pregnancy might explain this result. Both the Danish and the Scottish women who purchased prescription diuretics during their pregnancy were at increased risk of preterm delivery (< 37 completed weeks); ORs: 1.8 (CI; 1.2, 2.7)NJDP, 1.9 (CI; 0.9, 4.3)MEMO. The proportion of hypertension among women who purchased prescription thiazides was 15.8%, and the risk of having an infant with a birth weight (BW) < 2500 g was increased; ORs: 2.6 (CI; 1.4, 5.0)NJDP, 2.4 (CI; 0.8, 7.8)MEMO. CONCLUSIONS: Prescribing diuretics during pregnancy was associated with differences in birth weight and incidence of preterm delivery. Confounding by indication may explain the findings.

Individual use of antibiotics and prevalence of beta-lactamase production among bacterial pathogens from middle ear fluid.

Prescription data and clinical laboratory data were analysed to assess the influence of previous antibiotic therapy on the prevalence of beta-lactamase in isolates of Haemophilus influenzae and Moraxella catarrhalis from primary specimens of middle ear fluid from 2129 children aged 0-5 years. The prevalence of beta-lactamase-positive H. influenzae was 6.6% [95% confidence interval (CI): 3.5-9.8%] in children who received antibiotics 5-90 days before isolation of the organism compared with 7.0% (95% CI: 3.9-10.2%) in those who did not. The prevalence of beta-lactamase-positive M. catarrhalis was 90.9% (95% CI: 84.0-97.8%) in children who received antibiotics compared with 86.7% (95% CI: 79.0-94.4%) in those who did not.

[Repeat antibiotic prescriptions following treatment with sulfonamide or pivmecillinam. A survey of prescriptions among women aged 15-50 years in the county of Nordjylland]. / Indløsning af en ny antibiotikumrecept efter behandling med sulfonamid eller pivmecillinam. En receptundersøgelse blandt 15-50-årige kvinder i Nordjyllands Amt.

INTRODUCTION: A sulphonamide is the antibiotic of first choice for the treatment of uncomplicated urinary tract infections in Denmark. However, this recommendation has been challenged. MATERIAL AND METHODS: The study comprised 9,224 women, aged 15 to 50 years, who were residents in the County of North Jutland, Denmark. During 1997-1998 they had handed in a prescription from a general practitioner for either sulphonamide or pivmecillinam, but no other prescriptions for antibiotics during the preceding six months. Any antibiotic prescription handed in within the ensuing 31-day period was recorded, with the exception of macrolides. The proportion of women with a repeat prescription was a proxy for therapeutic failure. RESULTS: Eight thousand two hundred and sixty-nine women (89.6%) had handed in a prescription for a sulphonamide and 955 (10.4%) a prescription for pivmecillinam. A total of 1,490 women (16.2%) handed in a repeat prescription, i.e. 16.0% (95% confidence limits [CI] 15.2-16.8%) of women treated with sulphonamide and 17.8% (95% CI 15.4-20.4%) of women treated with pivmecillinam. The relative risk of a repeat prescription was 1.11 (95% CI 0.95-1.31) for women with a primary prescription for pivmecillinam, as compared to women with a sulphonamide prescription. Women who had handed in a sulphonamide prescription for less than three defined daily doses had an increased risk of a repeat prescription. DISCUSSION: The proportion of women with a repeat prescription did not differ much between women treated with sulphonamide and those treated with pivmecillinam. Controlled clinical trials should be performed before revision of current Danish recommendations are considered.

[Drug prescriptions for Danish children]. / Brug af receptpligtige laegemidler til danske børn.

We used a prescription database to identify all reimbursed prescriptions for children aged 0-15 years living in North Jutland County (population 95,134), Denmark, during 1997. We identified 154,189 prescriptions for 48,091 child users. The mean prescription rate was 1621/1000 children/year. Overall, half of the child population purchased > or = 1 prescription. In children younger than three years, 75.3% purchased prescriptions, and 17.5% received > or = 5 prescriptions. Systemic antibiotics, anti-asthmatics, ophthalmologicals, and dermatological corticosteroids accounted for 82% of the prescriptions. One-third of the 0-2 year old children purchased prescriptions for anti-asthmatics, mainly systemic beta 2-agonists, and almost half purchased antibiotics, mainly broad-spectrum penicillins. In the 7-15 year olds, 39.1% redeemed at least one prescription. The study stresses the need for epidemiological studies on the reasons for drug use and evaluation of pharmacological effects in children.

Multiple prescriptions of antibiotics for children aged 0 to 5 years in relation to type of antibiotic.

The risk of receiving more than one prescription within an antibiotic course was examined for all children aged 0 to 5 years in a Danish county during 1997. We identified 29,307 prescriptions of systemic antibiotics for 16,245 children in a prescription database. Ten per cent of the prescriptions were followed by a new prescription within 10 days. In children who received two prescriptions (n = 3993), 19% redeemed the prescriptions within the same course. When the child was prescribed penicillin V, compared with broad-spectrum penicillin, the odds ratio of receiving a repeat prescription within 1-2 days was 2.9 (95% CI 2.5-3.4) and within 3-10 days 1.3 (95% CI 1.2-1.5).

A one-year population-based study of drug prescriptions for Danish children.

We examined the pattern of prescribed drug use in Danish children and used a pharmacoepidemiological prescription database to identify all reimbursed prescriptions for children aged 0-15 y living in North Jutland County (population 95 189), Denmark, during 1997. We identified 154 189 prescriptions for 48 091 drug users. The 20 most frequently prescribed chemical substance subgroups comprised 71.3% of all prescriptions. The mean annual prescription rate was 1621/1000 children/y. Overall, 50.6% of the population received one or more prescription. In children younger than 3 y, 75.3% received prescriptions and 17.5% obtained five or more prescriptions. Systemic antibiotics, anti-asthmatics, ophthalmologicals and dermatological corticosteroids accounted for 82% of prescriptions. One-third of the young children received anti-asthmatics, mainly oral beta-2 agonists, and almost half received antibiotics, mainly broad-spectrum penicillins. In the 7-15-y-olds, 39.1% received prescriptions. Hormones, antihistamines, anti-epileptics, anti-acne preparations and anti-diabetics comprised an increasing proportion of prescriptions. About 20% received antibiotics and 6% anti-asthmatics. In conclusion, the level of exposure to prescribed drugs was considerable at all ages and was highest in early childhood. Our study supports the need for epidemiological studies on the reasons for drug use and evaluation of their pharmacological effects in children.

A population-based study of antibiotic prescriptions for Danish children.

BACKGROUND: The aim of the study was to examine the use of systemic and topical antibiotics in relation to age and sex in Danish children. METHODS: We used the Pharmacoepidemiological Prescription Database to identify the individual prescriptions of antibiotics provided for all 0-to 15-year-old children in North Jutland County, Denmark, during 1997. The population was approximately 95000 children. RESULTS: We identified 44640 prescriptions for systemic antibiotics. The annual prescription rate was highest in the 1- to 2-year-olds, with 945 prescriptions/1000 children/year. One-half of these children received at least 1 prescription, and 12% received 3 or more prescriptions. Among the 11- to 15-year-old children 17% received one or more prescriptions. Overall 88% of the prescriptions were penicillins and 10% were macrolides. In children younger than 3 years 57% of prescriptions were for broad spectrum penicillins, but in children older than 6 years penicillin V was the most frequently used antibiotic. We identified 12 661 prescriptions for topical antibiotics used in eye infections. The prescription rate peaked in the 1- to 2-year-old children, one-third of whom received at least 1 prescription. CONCLUSIONS: Almost two-thirds of the 0- to 2-year-old children in the population were treated with either systemic or topical antibiotics during 1 year. Physicians prescribe mostly penicillins, but the proportion of broad spectrum penicillins for young children was so high, however, that enforcement of national guidelines should be reconsidered.