{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T06:37:53Z","timestamp":1792996673028,"version":"4.5.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T00:00:00Z","timestamp":1641168000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T00:00:00Z","timestamp":1641168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The desired effect of antibiotics is compromised by the rapid escalation of antimicrobial resistance. Children are particularly at high-risk for unnecessary antibiotic prescribing, which is owing to clinicians\u2019 diagnostic uncertainty combined with parents\u2019 concerns and expectations. Recent Belgian data on ambulatory antibiotic prescribing practices for children are currently lacking. Therefore, we aim to analyse different aspects of antibiotic prescriptions for children in ambulatory care.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Pharmacy dispensing data on antibiotics for systematic use referring from 2010 to 2019 were retrieved from Farmanet, a database of pharmaceutical dispensations in community pharmacies. Population data were obtained from the Belgian statistical office (Statbel). Descriptive statistics were performed in Microsoft Excel. The Mann-Kendall test for trend analysis and the seasplot function for seasonality testing were conducted in R.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The past decade, paediatric antibiotic use and expenditures have relatively decreased in Belgian ambulatory care with 35.5% and 44.3%, respectively. The highest volumes of antibiotics for children are prescribed by GPs working in Walloon region and rural areas, to younger children, and during winter. The most prescribed class of antibiotics for children are the penicillins and the biggest relative reduction in number of packages is seen for the sulfonamides and trimethoprim and quinolone antibacterials.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Paediatric antibiotic use has decreased in Belgian ambulatory care. Further initiatives are needed to promote prudent antibiotic prescribing in ambulatory care.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12887-021-03047-7","type":"journal-article","created":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T07:03:20Z","timestamp":1641193400000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Using Belgian pharmacy dispensing data to assess antibiotic use for children in ambulatory care"],"prefix":"10.1186","volume":"22","author":[{"given":"Hannelore","family":"Dillen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Burvenich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tine","family":"De Burghgraeve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Y.","family":"Verbakel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,3]]},"reference":[{"key":"3047_CR1","doi-asserted-by":"crossref","unstructured":"Machowska A, Stalsby LC. Drivers of Irrational Use of Antibiotics in Europe. Int J Environ Res Public Health. 2018;16(1):1\u201314.","DOI":"10.3390\/ijerph16010027"},{"issue":"6","key":"3047_CR2","doi-asserted-by":"publisher","first-page":"e011497","DOI":"10.1136\/bmjopen-2016-011497","volume":"6","author":"HF Ashdown","year":"2016","unstructured":"Ashdown HF, Raisanen U, Wang K, Ziebland S, Harnden A, investigators A. Prescribing antibiotics to 'at-risk' children with influenza-like illness in primary care: qualitative study. BMJ Open. 2016;6(6):e011497.","journal-title":"BMJ Open"},{"issue":"3","key":"3047_CR3","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1136\/archdischild-2012-303134","volume":"98","author":"EG de Bont","year":"2013","unstructured":"de Bont EG, van Loo IH, Dukers-Muijrers NH, Hoebe CJ, Bruggeman CA, Dinant GJ, et al. Oral and topical antibiotic prescriptions for children in general practice. Arch Dis Child. 2013;98(3):228\u201331.","journal-title":"Arch Dis Child"},{"issue":"1","key":"3047_CR4","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1186\/1471-2431-14-207","volume":"14","author":"JY Verbakel","year":"2014","unstructured":"Verbakel JY, Lemiengre MB, De Burghgraeve T, De Sutter A, Bullens DM, Aertgeerts B, et al. Diagnosing serious infections in acutely ill children in ambulatory care (ERNIE 2 study protocol, part A): diagnostic accuracy of a clinical decision tree and added value of a point-of-care C-reactive protein test and oxygen saturation. BMC Pediatr. 2014;14(1):207.","journal-title":"BMC Pediatr"},{"issue":"623","key":"3047_CR5","doi-asserted-by":"publisher","first-page":"311","DOI":"10.3399\/bjgp14X680317","volume":"64","author":"A Van den Bruel","year":"2014","unstructured":"Van den Bruel A, Thompson M. Research into practice: acutely ill children. Br J Gen Pract. 2014;64(623):311\u20133.","journal-title":"Br J Gen Pract"},{"key":"3047_CR6","volume-title":"Het Rationeel Gebruik van de Antibiotica bij het Kind in de Ambulante Zorg","author":"RIZIV","year":"2016","unstructured":"RIZIV. Het Rationeel Gebruik van de Antibiotica bij het Kind in de Ambulante Zorg. 2016."},{"key":"3047_CR7","unstructured":"BAPCOC. Belgische Gids voor Anti-Infectieuze Behandeling in de Ambulante Praktijk 2019 [Available from: https:\/\/www.bcfi.be\/nl\/chapters\/12?frag=8000010. Accessed 20\/10\/2020.]"},{"issue":"4","key":"3047_CR8","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1080\/02813432.2018.1529900","volume":"36","author":"MB Lemiengre","year":"2018","unstructured":"Lemiengre MB, Verbakel JY, Colman R, Van Roy K, De Burghgraeve T, Buntinx F, et al. Point-of-care CRP matters: normal CRP levels reduce immediate antibiotic prescribing for acutely ill children in primary care: a cluster randomized controlled trial. Scand J Prim Health Care. 2018;36(4):423\u201336.","journal-title":"Scand J Prim Health Care"},{"issue":"1","key":"3047_CR9","doi-asserted-by":"publisher","first-page":"e025036","DOI":"10.1136\/bmjopen-2018-025036","volume":"9","author":"JY Verbakel","year":"2019","unstructured":"Verbakel JY, Lee JJ, Goyder C, Tan PS, Ananthakumar T, Turner PJ, et al. Impact of point-of-care C reactive protein in ambulatory care: a systematic review and meta-analysis. BMJ Open. 2019;9(1):e025036.","journal-title":"BMJ Open"},{"issue":"1","key":"3047_CR10","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3109\/02813432.2015.1001942","volume":"33","author":"PJ Lucas","year":"2015","unstructured":"Lucas PJ, Cabral C, Hay AD, Horwood J. A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care. Scand J Prim Health Care. 2015;33(1):11\u201320.","journal-title":"Scand J Prim Health Care"},{"issue":"668","key":"3047_CR11","doi-asserted-by":"publisher","first-page":"e204","DOI":"10.3399\/bjgp18X695033","volume":"68","author":"MB Lemiengre","year":"2018","unstructured":"Lemiengre MB, Verbakel JY, Colman R, De Burghgraeve T, Buntinx F, Aertgeerts B, et al. Reducing inappropriate antibiotic prescribing for children in primary care: a cluster randomised controlled trial of two interventions. Br J Gen Pract. 2018;68(668):e204\u2013e10.","journal-title":"Br J Gen Pract"},{"key":"3047_CR12","unstructured":"Leroy R, Christiaens W, Maertens de Noordhout C, Hanquet G. Proposals for a more effective antibiotic policy in Belgium - Report. KCE. 2019."},{"key":"3047_CR13","volume-title":"Antimicrobial consumption in the EU\/EEA","author":"ECDC","year":"2019","unstructured":"ECDC. Antimicrobial consumption in the EU\/EEA. 2019."},{"key":"3047_CR14","volume-title":"Infospot - Antibiotica bij het kind in de ambulante zorg","author":"RIZIV","year":"2016","unstructured":"RIZIV. Infospot - Antibiotica bij het kind in de ambulante zorg. 2016."},{"key":"3047_CR15","unstructured":"RIZIV. Statistieken over geneesmiddelen afgeleverd in openbare apotheken (Farmanet) 2013 [Available from: https:\/\/www.riziv.fgov.be\/nl\/statistieken\/geneesmiddel\/Paginas\/Statistieken-geneesmiddelen-apotheken-farmanet.aspx. Accessed 11\/12\/2020.]"},{"issue":"XX","key":"3047_CR16","first-page":"1","volume":"XX","author":"R Bruyndonckx","year":"2020","unstructured":"Bruyndonckx R, Coenen S, Hens N, Vandael E, Catry B, Goossens H. Antibiotic use and resistance in Belgium: the impact of two decades of multi-faceted campaigning. Acta Clin Belg. 2020;XX(XX):1\u20139.","journal-title":"Acta Clin Belg"},{"key":"3047_CR17","unstructured":"World Health Organisation. Defined Daily Dose (DDD) 2020 [Available from: https:\/\/www.who.int\/toolkits\/atc-ddd-toolkit\/about-ddd. Accessed 8\/12\/2020.]"},{"key":"3047_CR18","unstructured":"STATBEL. Structuur van de bevolking 2020 [Available from: https:\/\/statbel.fgov.be\/nl\/themas\/bevolking\/structuur-van-de-bevolking#news. Accessed 24\/12\/2020.]"},{"key":"3047_CR19","unstructured":"Vlaams Parlement. Structuur van Belgi\u00eb 2021 [Available from: https:\/\/www.vlaamsparlement.be\/over-het-vlaams-parlement\/het-vlaams-parlement-het-politieke-landschap\/structuur-van-belgi%C3%AB. Accessed 26\/05\/2021.]"},{"key":"3047_CR20","unstructured":"European Commission. Degree of Urbanisation (DEGURBA) - Local Administrative Units 2019 [Available from: https:\/\/ec.europa.eu\/eurostat\/ramon\/miscellaneous\/index.cfm? TargetUrl=DSP_DEGURBA. Accessed 11\/12\/2020.]"},{"key":"3047_CR21","unstructured":"Chevalier P, Leconte S, De Sutter A. Belgische Gids voor Anti-Infectieuze Behandeling in de Ambulante Praktijk. BAPCOC. 2012;1:1\u201384."},{"key":"3047_CR22","volume-title":"Domus Medica","author":"E-learning om antibioticaverbruik te verminderen","year":"2017","unstructured":"E-learning om antibioticaverbruik te verminderen. Domus Medica. 2017."},{"key":"3047_CR23","unstructured":"RIZIV. De LOK, lokale kwaliteitsgroep 2014 [Available from: https:\/\/www.inami.fgov.be\/nl\/professionals\/individuelezorgverleners\/artsen\/kwaliteit\/accreditering\/Paginas\/artsen-accreditering-LOK-index.aspx. Accessed 18\/11\/2020.]"},{"key":"3047_CR24","unstructured":"RIZIV. Antibiotica : terugbetaling vanaf 1 mei 2017 2017 [Available from: https:\/\/www.riziv.fgov.be\/nl\/themas\/kost-terugbetaling\/door-ziekenfonds\/geneesmiddel-gezondheidsproduct\/terugbetalen\/specialiteiten\/wijzigingen\/Paginas\/antibiotica-20170501.aspx. Accessed 26\/10\/2020.]"},{"key":"3047_CR25","unstructured":"RIZIV. Antibiotica die tot de klasse van de (fluoro) chinolonen behoren: terugbetaling vanaf 1 mei 2018 2018 [Available from: https:\/\/www.riziv.fgov.be\/nl\/themas\/kost-terugbetaling\/door-ziekenfonds\/geneesmiddel-gezondheidsproduct\/terugbetalen\/specialiteiten\/wijzigingen\/Paginas\/antibiotica-fluoro-chinolonen.aspx. Accessed 26\/10\/2020.]"},{"key":"3047_CR26","volume-title":"Afleveren van het goedkoopste geneesmiddel bij - voorschrijven op stofnaam - antibiotica en antimycotica","author":"RIZIV","year":"2012","unstructured":"RIZIV. Afleveren van het goedkoopste geneesmiddel bij - voorschrijven op stofnaam - antibiotica en antimycotica. 2012."},{"issue":"5-6","key":"3047_CR27","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1111\/jocn.14073","volume":"27","author":"H Bosley","year":"2018","unstructured":"Bosley H, Henshall C, Appleton JV, Jackson D. A systematic review to explore influences on parental attitudes towards antibiotic prescribing in children. J Clin Nurs. 2018;27(5-6):892\u2013905.","journal-title":"J Clin Nurs"},{"key":"3047_CR28","unstructured":"Europese Raad. EU neemt maatregelen aan om producenten van generieke geneesmiddelen te ondersteunen 2019 [Available from: https:\/\/www.consilium.europa.eu\/nl\/press\/press-releases\/2019\/05\/14\/eu-adopts-measures-in-support-of-generic-pharmaceuticals-producers\/. Accessed 23\/03\/2021.]"},{"key":"3047_CR29","unstructured":"FOD Economie. Generieke geneesmiddelen 2019 [Available from: https:\/\/economie.fgov.be\/nl\/themas\/verkoop\/prijsbeleid\/gereguleerde-prijzen\/geneesmiddelen-voor-menselijk\/generieke-geneesmiddelen. Accessed 28\/01\/2021.]"},{"key":"3047_CR30","doi-asserted-by":"crossref","unstructured":"Trinh NTH, Bruckner TA, Lemaitre M, Chauvin F, Levy C, Chahwakilian P, et al. 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;216:88\u201394.","DOI":"10.1016\/j.jpeds.2019.09.017"},{"key":"3047_CR31","first-page":"1033","volume":"87","author":"AA-O Cangini","year":"2020","unstructured":"Cangini AA-O, Fortinguerra FA-O, Di Filippo A, Pierantozzi A, Da Cas R, Villa F, et al. Monitoring the community use of antibiotics in Italy within the National Action Plan on antimicrobial resistance. Br Pharmacol Soc. 2020;87:1033\u201342.","journal-title":"Br Pharmacol Soc"},{"key":"3047_CR32","doi-asserted-by":"crossref","unstructured":"Gradl GA-OX, Teichert MA-O, Kieble M, Werning J, Schulz MA-O. Comparing outpatient oral antibiotic use in Germany and the Netherlands from 2012 to 2016. Pharmacoepidemiol Drug Saf. 2018(27):1344\u201355.","DOI":"10.1002\/pds.4643"},{"key":"3047_CR33","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1093\/eurpub\/ckp040","volume":"19","author":"G Lusini","year":"2009","unstructured":"Lusini G, Lapi F, Fau-Sara B, Sara B Fau-Vannacci A, Vannacci A Fau-Mugelli A, Mugelli A Fau-Kragstrup J, Kragstrup J Fau-Bjerrum L, et al. Antibiotic prescribing in paediatric populations: a comparison between Viareggio, Italy and Funen, Denmark. Eur J Pub Health. 2009;19:434\u20138.","journal-title":"Eur J Pub Health"},{"key":"3047_CR34","doi-asserted-by":"crossref","unstructured":"Hicks LA, Bartoces MG, Roberts RM, Suda KJ, Hunkler RJ, Taylor TH Jr, et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. CID. 2015;60:1308\u201316.","DOI":"10.1093\/cid\/civ076"},{"key":"3047_CR35","unstructured":"BCFI. Infecties [Available from: https:\/\/www.bcfi.be\/nl\/chapters\/12?frag=9423. Accessed 16\/12\/2020.]"},{"key":"3047_CR36","unstructured":"UZ Leuven. Kindergeneeskunde 2021 [Available from: https:\/\/www.uzleuven.be\/nl\/kindergeneeskunde. Accessed 28\/01\/2021.]"},{"issue":"4","key":"3047_CR37","first-page":"277","volume":"40","author":"CL Ventola","year":"2015","unstructured":"Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015;40(4):277\u201383.","journal-title":"P T"},{"issue":"612","key":"3047_CR38","doi-asserted-by":"publisher","first-page":"e437","DOI":"10.3399\/bjgp13X669158","volume":"63","author":"G Elshout","year":"2013","unstructured":"Elshout G, van Ierland Y, Bohnen AM, de Wilde M, Oostenbrink R, Moll HA, et al. Alarm signs and antibiotic prescription in febrile children in primary care: an observational cohort study. Br J Gen Pract. 2013;63(612):e437\u201344.","journal-title":"Br J Gen Pract"},{"issue":"12","key":"3047_CR39","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1007\/s00228-007-0376-3","volume":"63","author":"A Rossignoli","year":"2007","unstructured":"Rossignoli A, Clavenna A, Bonati M. Antibiotic prescription and prevalence rate in the outpatient paediatric population: analysis of surveys published during 2000-2005. Eur J Clin Pharmacol. 2007;63(12):1099\u2013106.","journal-title":"Eur J Clin Pharmacol"},{"issue":"8","key":"3047_CR40","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1007\/s00228-009-0679-7","volume":"65","author":"A Clavenna","year":"2009","unstructured":"Clavenna A, Bonati M. Drug prescriptions to outpatient children: a review of the literature. Eur J Clin Pharmacol. 2009;65(8):749\u201355.","journal-title":"Eur J Clin Pharmacol"},{"key":"3047_CR41","unstructured":"ECDC. Facts about antimicrobial resistance 2021 [Available from: https:\/\/www.ecdc.europa.eu\/en\/antimicrobial-resistance\/facts. Accessed 27\/01\/2021.]"},{"key":"3047_CR42","doi-asserted-by":"crossref","unstructured":"Armitage R, Nellums LB. Antibiotic prescribing in general practice during COVID-19. Lancet Infect Dis. 2020;21:e144.","DOI":"10.1016\/S1473-3099(20)30917-8"}],"updated-by":[{"DOI":"10.1186\/s12887-022-03152-1","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T00:00:00Z","timestamp":1646956800000}}],"container-title":["BMC Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-021-03047-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12887-021-03047-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-021-03047-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,12]],"date-time":"2022-03-12T07:03:21Z","timestamp":1647068601000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpediatr.biomedcentral.com\/articles\/10.1186\/s12887-021-03047-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,3]]},"references-count":42,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["3047"],"URL":"https:\/\/doi.org\/10.1186\/s12887-021-03047-7","relation":{"correction":[{"id-type":"doi","id":"10.1186\/s12887-022-03152-1","asserted-by":"object"}]},"ISSN":["1471-2431"],"issn-type":[{"value":"1471-2431","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,3]]},"assertion":[{"value":"9 September 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2022","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1186\/s12887-022-03152-1","URL":"https:\/\/doi.org\/10.1186\/s12887-022-03152-1","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"12"}}