{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T06:56:32Z","timestamp":1769583392202,"version":"3.49.0"},"reference-count":37,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/objective: Inappropriate antibiotic use in paediatric populations is a leading driver of antimicrobial resistance. In the Murcia Region, Spain, the Purapi program promotes the rational use of antibiotics among children under 3 years of age. This study aimed to analyse antibiotic use in this age group during the pandemic period (2020\u20132023) and to assess the impact of the COVID-19 pandemic on the effectiveness of a multifaceted program promoting appropriate antibiotic use. Methods: A retrospective, multicentre, population-based study was conducted in primary care using data from 2019 to 2024. Systemic antibiotic use (ATC J01 group) among children under three years was measured as defined daily doses per 1000 inhabitants per day (DHD). Differences across years and healthcare areas were assessed using analysis of variance (ANOVA) with Bonferroni correction. Results: Antibiotic consumption decreased by 49% in 2020 compared to 2019, coinciding with the implementation of national COVID-19 containment measures. From 2021 onward, a gradual increase was observed; however, by 2024, levels remained 9% below pre-pandemic values. Penicillins account for 75% of prescriptions, mainly amoxicillin and amoxicillin\u2013clavulanic acid. While variability across healthcare areas decreased during the pandemic, variability among primary care centres increased. Conclusions: The pandemic resulted in a temporary reduction in antibiotic use, followed by a partial rebound. Ongoing educational and stewardship interventions within the Purapi framework were instrumental in maintaining rational prescribing and may have contributed to maintaining reduced antibiotic consumption among children under three years of age during and after the pandemic. Strengthening and harmonising these initiatives is essential to ensure consistent paediatric antibiotic stewardship in primary care.<\/jats:p>","DOI":"10.3390\/antibiotics15010101","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T08:36:33Z","timestamp":1768898193000},"page":"101","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of the COVID-19 Pandemic on the Outcomes of a Multifaceted Program on Antibiotic Prescribing in Primary Care Among Children Under Three Years of Age"],"prefix":"10.3390","volume":"15","author":[{"given":"Gema","family":"Mart\u00edn-Ayala","sequence":"first","affiliation":[{"name":"General Directorate of Health Planning, Research, Pharmacy and Citizen Services, Health Counseling of Murcia Region, E-30001 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2664-3736","authenticated-orcid":false,"given":"Santiago","family":"Alfayate-Migu\u00e9lez","sequence":"additional","affiliation":[{"name":"Research Group of Murciano Institute of Biosanitary Research, IMIB, E-30120 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Casimiro","family":"Jim\u00e9nez-Guill\u00e9n","sequence":"additional","affiliation":[{"name":"General Directorate of Health Planning, Research, Pharmacy and Citizen Services, Health Counseling of Murcia Region, E-30001 Murcia, Spain"},{"name":"National Plan for Antibiotic Resistance (PRAN) in Murcia Region, E-30001 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Alcaraz-Qui\u00f1onero","sequence":"additional","affiliation":[{"name":"Health Care Center of Yecla, V Health Area, E-30510 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0525-0995","authenticated-orcid":false,"given":"Antonio","family":"Iofr\u00edo-De Arce","sequence":"additional","affiliation":[{"name":"Health Care Center \u201cEl Ranero\u201d, VI Health Area, E-30009 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4617-0879","authenticated-orcid":false,"given":"Jos\u00e9","family":"Arnau-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"General Directorate of Health Planning, Research, Pharmacy and Citizen Services, Health Counseling of Murcia Region, E-30001 Murcia, Spain"},{"name":"Research Group of Murciano Institute of Biosanitary Research, IMIB, E-30120 Murcia, Spain"},{"name":"Nursing Faculty, Health Sciences Campus, University of Murcia, E-30120 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e20200038","DOI":"10.1542\/peds.2020-0038","article-title":"Reducing Antibiotic Prescribing in Primary Care for Respiratory Illness","volume":"146","author":"Kronman","year":"2020","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1542\/peds.2011-1337","article-title":"Antibiotic prescribing in ambulatory pediatrics in the United States","volume":"128","author":"Hersh","year":"2011","journal-title":"Pediatrics"},{"key":"ref_3","first-page":"272","article-title":"The Burden and Impact of Antibiotic Prescribing in Ambulatory Pediatrics","volume":"48","author":"Yonts","year":"2018","journal-title":"Curr. 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