BMC Public Health. 2026 Jan 26;26(1):311. doi: 10.1186/s12889-025-25657-x.
ABSTRACT
BACKGROUND: Antibiotics are among the most frequently prescribed medications for pediatric patients. Inappropriate use, particularly in the first years of life, can contribute to the development of antibiotic resistances and impact the maturation of the gut microbiome. Describing prescription patterns using nationally collected data is essential for identifying or monitoring existing strategies for reducing excessive use. This study aims to identify antibiotic prescription trajectories during the first four years of life and to investigate their association with sociodemographic factors.
METHODS: In this retrospective cohort study, we used data collected through the Pedianet registry, a monitoring system involving approximately 200 family pediatricians (FPs) in Italy. We considered children born between 2004 and 2018 with complete follow-up during their first four years of life, excluding those with a birth weight of < 2500 g, gestational age < 37 weeks or genetic disorders. Prescription trajectories over the 16 trimesters of observation were estimated using Group-Based Trajectory Modelling (GBTM), by classifying the included children into homogeneous groups based on their probabilities of membership. The association between trajectories and sociodemographic factors was examined with multinomial logistic regression with random intercepts for FPs.
RESULTS: A total of 143,098 children born between 01/01/2004 and 31/12/2018 were included. Between 0 and 4 years of age, these children received a total of 684,010 antibiotic prescriptions. GBTM identified four different trajectories, defined as: [1] “very low use” of antibiotics (34.9% of children) [2], “low-to-moderate use” (22.8%) [3], “moderate-to-low use” (28.0%) and [4] “high use” (14.3%). Compared to the “very low use” trajectory, male subjects residing in the center and south of Italy and born between 2004 and 2008 had a higher probability of belonging to trajectory groups with “moderate-to-low use” and “high use”.
CONCLUSIONS: From 2004 to 2022 in Italy, we observed heterogeneous antibiotic prescription patterns among children aged 0-4 years. Future strategies aimed at reducing the number of prescriptions in this age group should target the subgroups at higher risk.
PMID:41588382 | DOI:10.1186/s12889-025-25657-x
