Antibiotics seemed to be used less frequently in Oslo’s child day-care centres in 2006 than in the same type of cohort in 2000. Our findings also show that the number of infections, with the exception of eye infections, was lower and that the number of medical consultations per child was lower. Antibiotics were given to one in two children who saw a doctor in 2006 and four in five children in 2000.
The low response rate, great variation among the day-care centres and the study’s retrospective character may have affected the reliability of the findings. The level of education seems to be higher for our cohort than for this age group in Oslo’s total population. Education beyond secondary level has not, however, been specified so it is hard to say how representative the study group is in this respect. As for retrospective studies in general; the medical diagnoses must be interpreted with care, standardized terms have not been used but often rather trivial descriptions and the parents’ «diagnoses». The same considerations expressed in the previous study also apply here (3).
Fewer infections per child may be due to annual variation in climate and weather, which can affect the frequency of respiratory infections. Annual epidemics such as influenza vary both in length and virulence and may directly or indirectly influence the prevalence of infections. Recent studies indicate that the annual incidence of ear and respiratory infections in general may have declined in recent years. Fewer consultations may partly be explained by fewer episodes of infection, but may also be caused by a higher threshold for contacting a doctor (indicated by other studies) (8, 9). The number of children and infections treated with antibiotics is anyhow significantly reduced, which may be explained in many ways. As very few parents were familiar with the information brochures, these do not seem to be directly linked with the reduction in consumption but, indirectly, they may have had functioned as information and reminders to doctors and other medical staff. Previous information campaigns have been shown to affect both medical staff and parents (10, 11), but it is not always easy for parents to remember where they have heard what.
Mass media focus on bacterial resistance in recent years may have had an indirect influence. At the same time, the Internet seems to become increasingly important as a source of knowledge and help in medical questions. A recent interview survey shows that 58 % of the population uses the Internet for medical matters, and that women do so more frequently than men (12). Increased knowledge and information about childhood infections will probably make the parents feel more confident about their own competence so they do not consider it necessary to see a doctor or use antibiotics for uncomplicated infections. Moreover, greater job flexibility and better chances to work from home means less stress in dealing with sick children. The fact that the cohort was well-educated may also have led to a lower demand for antibiotics. A lower mean age for the children may have been an important reason for fewer courses of treatment.
The implementation of a regular GP scheme in 2001 probably contributed to a reduction in consumption. Doctors participating in out-of-hours services and other doctors who do not know the patient have previously shown a tendency to prescribe antibiotics more frequently than regular GPs (13, 14). Fewer parents claimed that they had seen a new doctor in 2006 than was the case in 2000 (3). Also, more than half of the parents stated that they had received information on the subject from their doctor and, in their comments concerning medical consultations, parents wrote that regular GPs are more restrictive than out-of-hours doctors. This is confirmed by the fact that fewer parents now than in previous studies believe doctors prescribe too many antibiotics. Furthermore, «wait and see» prescriptions may have been used more, although this was not specifically mentioned. Other studies have shown that such prescriptions contribute to use of less antibiotics (15, 16).
Our results from Oslo’s day-care centres show that the consumption of antibiotics among children is reduced, which indicates a more restrictive prescription practice. Yet the numbers indicate that some infections are still being treated unnecessarily. On a worldwide basis, the problem of resistance will probably increase in the years ahead, which further emphasizes the need for a cautious use of antimicrobial agents.