Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions

Figures & data

Figure 1. Flow chart of the enrolled prescriptions for children aged 2–14 with URI in rural Guangxi, China (2014).

Table 1. General characteristics of prescriptions among children aged 2–14 with URI stratified by health facility level in Guangxi, rural China (2014).

	County hospital	Township hospital	Village clinic	Total
Total URI prescriptions	8166	877	297	9340
Gender
Male	4769 (58)	491 (56)	156 (53)	5416 (58)
Female	3397 (42)	386 (44)	141 (48)	3924 (42)
Age group*
2–5	6499 (80)	479 (55)	139 (47)	7117 (76)
6–14	1667 (20)	396 (45)	158 (53)	2223 (24)
Diagnoses^a*
J00	45 (< 1)	401 (46)	23 (8)	469 (5)
J01	3 (< 1)	0	0	3 (< 1)
J02	140 (2)	45 (5)	6 (2)	191 (2)
J03	17 (< 1)	59 (7)	16 (5)	92 (1)
J05	0	1 (< 1)	0	1 (< 1)
J06	7961 (98)	371 (42)	252 (85)	8584 (92)
Payment method*
With insurance copayment	2354 (29)	285 (32)	232 (78)	2871 (31)
Fully out-of-pocket	3478 (43)	561 (64)	3 (1)	4042 (43)
Unknown	2334 (28)	31 (4)	62 (21)	2427 (26)
Average number of medicines*	6 (±5)	3 (±2)	2 (±1)	5 (±5)
Average prescription fee (USD)*	15 (±34)	4 (±3)	2 (±1)	14 (±5)
< 8	5570 (68)	761 (87)	295 (99)	6626 (71)
8–32	1560 (19)	116 (13)	2 (1)	1678 (18)
> 32	1036 (13)	0	0	1036 (11)
Date of prescription^b**
Working days	5683 (70)	521 (70)	192 (77)	6396 (70)
Weekends	2483 (30)	222 (30)	56 (23)	2761 (30)

Notes: Data are n (%) or mean (± standard deviation). ANOVA or chi-square test was used to find the statistical difference among health facilities of three levels: *p < 0.001; **p < 0.05.

J00 = Acute nasopharyngitis (common cold); J01 = Acute sinusitis; J02 = Acute pharyngitis; J03 = Acute tonsillitis; J05 = Acute obstructive laryngitis (croup) and epiglottitis; J06 = Acute upper respiratory infections of multiple and unspecified sites.

Missing values were excluded for proportion calculations: 134 (15.3%) and 49 (16.5%) missing values in township hospitals and village clinics for date of prescription.

Table 2. Antibiotics prescribing rate and characteristics of prescribed antibiotics among children aged 2–14 with URI stratified by health facility level in rural Guangxi, China (2014).

	County hospital	Township hospital	Village clinic	Total
Total URI prescriptions	8166	877	297	9340
Total prescriptions with antibiotics*	2736 (34)	593 (68)	96 (32)	3425 (37)
No. of antibiotics prescribed*
1	1438 (53)	506 (85)	96 (100)	2040 (59)
2	558 (20)	82 (14)	0	640 (19)
≥ 3	740 (27)	5 (1)	0	745 (22)
Category of antibiotics^a
Penicillin^b***	1212 (44)	301 (51)	32 (33)	1545 (45)
Broad-spectrum penicillin	640 (53)	173 (58)	15 (47)	828 (54)
Narrow-spectrum penicillin*	695 (57)	131 (44)	17 (53)	843 (55)
Cephalosporin*	2019 (74)	208 (35)	28 (29)	2255 (66)
Cephalosporin I*	492 (24)	96 (46)	23 (82)	611 (27)
Cephalosporin II*	1257 (62)	57 (27)	2 (7)	1316 (58)
Cephalosporin III*	1300 (64)	75 (36)	3 (11)	1378 (61)
Macrolides**	238 (9)	37 (6)	4 (4)	279 (8)
Lincosamides*	109 (4)	59 (10)	0	168 (5)
Aminoglycosides*	10 (< 1)	40 (7)	32 (33)	82 (2)
Quinolones	0	1 (< 1)	0	1 (< 1)
Spectrum category of antibiotics*
Narrow-spectrum only	502 (18)	255 (43)	44 (46)	801 (23)
Including broad-spectrum	2234 (82)	338 (57)	52 (54)	2624 (77)
Prescription type*
Oral antibiotics only	956 (35)	336 (57)	64 (67)	1356 (40)
Including injectable	1780 (65)	257 (43)	32 (33)	2069 (60)
Average prescription fee (USD)*	38 (±50)	5 (±3)	2 (±1)	31 (±47)
< 8	653 (24)	484 (82)	96 (100)	1233 (36)
8–32	1067 (39)	109 (18)	0	1176 (34)
> 32	1016 (37)	0	0	1016 (30)

Notes: Data are n (%) or mean (± standard deviation). ANOVA or chi-square test was used to find the statistical difference among health facilities of three levels: *p < 0.001; **p < 0.05; ***p < 0.01.

More than one category of antibiotics may be prescribed in one prescription, thus the proportion may add up to more than 100%.

Penicillin included first generation of penicillin (penicillin G, penicillin V, procaine penicillin, and benzathine penicillin) and second/third generation of penicillin.

Table 3. Factors associated with antibiotic prescriptions among children aged 2–14 with URI in rural Guangxi, China (2014).

	Total URI prescriptions	Antibiotics prescribed, n (%)	Crude odds ratio	Adjusted odds ratio^a
				aOR (95% CI)	p-value
Gender
Male	5416	1394 (38)	1.1 (1.0–1.2)	0.9 (0.8–1.0)	0.184
Female	3924	2031 (36)	Ref	Ref
Age
2–5 years	7117	2358 (33)	Ref	Ref
6–14 years	2223	1067 (95)	1.9 (1.7–2.1)	1.3 (1.2–1.5)	< 0.001
URI type^b
URI of specified anatomical sites	756	581 (77)	6.7 (5.6–8.0)	7.7 (6.2–9.5)	< 0.001
URI of unspecified anatomical sites	8584	2844 (33)	Ref	Ref
Payment method
Unknown	2427	2073 (85)	20.0 (17.5–22.9)	38.4 (33.2–44.6)	< 0.001
With insurance copayment	2871	436 (15)	0.6 (0.5–0.7)	0.8 (0.7–0.9)	< 0.001
Fully out-of-pocket	4042	916 (23)	Ref	Ref
Health facility level
County hospital	8166	2736 (34)	Ref	Ref
Township hospital	877	593 (68)	4.1 (3.6–4.8)	5.0 (4.1–6.0)	< 0.001
Village clinic	297	96 (32)	0.9 (0.7–1.2)	1.1 (0.8–1.6)	0.657

Notes: aOR was calculated using binary logistic regression.

URI of specified anatomical sites: acute nasopharyngitis (common cold), acute sinusitis, acute pharyngitis, acute tonsillitis, acute obstructive laryngitis (croup) and epiglottitis; URI of unspecified anatomical sites: acute upper respiratory infections of multiple and unspecified sites.

Table 4. Number, class and type of antibiotics prescribed among children aged 2–14 with URI stratified by payment method in rural Guangxi, China (2014).

	With insurance copayment	Fully out-of-pocket	Total
Total URI prescriptions	2871	4042	6913
Average prescription fee (USD)*	4 (±3)	5 (±5)	4 (±4)
< 8	2591 (90)	3508 (87)	6099 (88)
8–32	278 (10)	520 (13)	798 (12)
> 32	2 (< 0.1)	14 (< 1)	16 (< 1)
Prescriptions with antibiotics*	436 (15)	916 (23)	1352 (20)
No. of antibiotics prescribed
1	396 (91)	831 (91)	1227 (91)
2	36 (8)	84 (9)	120 (9)
≥ 3	4 (1)	1 (< 0.1)	5 (< 0.1)
Spectrum category of antibiotics***
Narrow-spectrum only	153 (35)	409 (45)	562 (42)
Including broad-spectrum	283 (65)	507 (55)	790 (58)
Prescription type
Oral antibiotics only	268 (62)	525 (57)	793 (59)
Including injectable	168 (38)	391 (43)	559 (41)

Notes: Data are n (%) or mean (± standard deviation). T-test or chi-square test was used to find the statistical difference between payment method groups: *p < 0.001; ***p < 0.01.