(273) Medicine use in children aged under 12  years in Serbia: a focus on antibiotics

Background: The misuse and overuse of antibiotics pose significant challenges to public health in Serbia. Limited data is avialable on the use of antibiotics in children.

Objectives: To study the prevalence of medicine use, focusing on antibiotics, in children under 12 years of age in Serbia.

Methods: This cross-sectional study was conducted using an online survey between November 2023 and January 2024 in Novi Sad, Serbia. The survey was administered to parents or guardians of children under 12 years using social-media platforms.

Results: Based on the answers of 1239 respondents, one-year prevalence of medication use in children under 12 in Serbia was 74.1%. Use of medicines was more commonly reported by parents (guardians) with higher education (p=0.03), and those living in single child households (p < 0.01). The highest prevalence of use was found for antipyretics (63.0%) and antibiotics (54.1%), followed by inhalations (46.9%), and cough syrups (42.4%). Antipyretics were most commonly used for self-medication, while almost all (99.3%) antibiotics were obtained by prescription. Use of antibiotics in previous year was more common in children going to school or kindergarten than those who do not (57.3% vs 39.2% p=0.02). Child's age, number of siblings, house-hold size, chronic disease in children did not affect antibiotic use. The most commonly used antibiotics were 2nd and 3rd gen cephalosporins (31.2%), co-amoxiclav (30.3%), amoxicillin (22.7%) and azithromycin (10.01%). The most common indications were upper respiratory tract infections presenting with runny nose and cough (46.7%), middle ear infections (23.78%) and strep-throat (10.57%). Out of children taking antibiotics, 44.8% used antibiotics once, 34.4% used them twice and 22.2% used antibiotics three times in previous year. Majority of respondents claimed administering antibiotics as prescribed (78.9%), while 19.2% reported administering antibiotics until they finished the whole pack. Just 2.4% reported stopping giving antibiotics because symptoms resolved. Some misconceptions were identified - 13.0% of respondent claimed that antibiotics are effective in reducing fever and 21.0% in treating cold or flu. About 20.0% of respondents said that they avoid giving any medicines to children, and 65.4% avoid giving antibiotics. However, 9.6% confirmed that they keep a package of antibiotics at home, just in case.

Conclusions: Most common medicines reported to be used in children younger than 12 in Serbia were antipyretics and antibiotics. Considering that almost all antibiotics were obtained with prescription, widespread use of broad-spectrum antibiotics and use of antibiotics for upper respiratory tract infections identify areas for improvement in prescribing practices of physicians in Serbia.