Antibiotic use among Danish children and adolescents 2010–2023: a nationwide drug utilisation study

Antibiotics are frequently prescribed to children, often for respiratory infections that do not require treatment. Inappropriate use contributes to antimicrobial resistance and adverse health outcomes. The aim of this study was to examines systemic antibiotic prescribing trends in Danish children (2010–2023), focusing on prevalence, quantity, and temporal changes. A nationwide drug utilisation study based on redeemed prescriptions from the Danish National Prescription Registry for children under 18 years from 1 January 2010, to 31 December 2023. Annual prevalence and incidence rates (IR) of antibiotic use were calculated, stratified by age, sex, region, and antibiotic type, classified by drug class and WHO AWaRe classification. A total of 5,518,308 antibiotic prescriptions were issued to 1,426,043 children. The highest IR was observed in 1-year-olds. Antibiotic prescriptions declined from 440 per 1,000 children in 2010 to 235 in 2019, followed by a sharp drop in 2020 (165 per 1,000) coinciding with the Covid-19 pandemic lockdown. However, IRs rose steeply post-pandemic, surpassing 2019 levels and reaching 287 per 1,000 children in 2023. Beta-lactamase-sensitive penicillins and extended-spectrum penicillins were the most prescribed antibiotics. A shift towards antibiotics associated with lower risk as per WHO AWaRe classification was noted, with variations by age, sex, and region. Overall, a trend towards a more rational pattern in antibiotic prescriptions was observed among Danish children between 2010 and 2020. However, a steep increase in the prescription rate of antibiotics from 2021 and onwards warrants closer monitoring.