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Research update: Amoxicillin in under-5s

Research update: Amoxicillin in under-5s

Lucille Kelsall-Knight summarises recent research into amoxicillin prescribing among infants

Factors predicting amoxicillin prescribing in primary care among children: a cohort study1

Each year in England, around a third of under-fives are prescribed at least one antibiotic2, and three-quarters of antibiotics prescribed to children in primary care are for respiratory tract infections (RTIs).3,4 Antibiotic prescribing contributes to antimicrobial resistance, which is a public health emergency.5

Miller and colleagues (2022)1 aimed to identify factors associated with amoxicillin prescribing and consultation for RTIs in primary care among young children. They undertook a cohort study in the city of Bradford in northern England with data from pregnancy to 24 months of age, collected between 2007-2013 from electronic primary care and air pollution data. They calculated the prescribing rates per 1,000 child-years to establish risk factors for amoxicillin prescribing and RTI consultation during the first two years of life. 

Among 2,493 children studied, the amoxicillin prescribing rate was 710/1,000 child-years during the first year and 780/1,000 during the second year. Prescribing during year one was increased for infants who were male, socio-economically deprived and had a Pakistani ethnic background (around 27% of Bradford’s population are of south Asian heritage). The chances of being prescribed amoxicillin during the second year were higher for infants with a Pakistani ethnic background and pre-/early-term infants. Additional risk factors for antibiotic prescribing included caesarean delivery, congenital irregularities, overcrowded households and attending a childcare setting. 

Overall, this research suggests a child’s socio-economic status and ethnic background are strongly associated with amoxicillin prescribing and consultations for RTIs in primary care during childhood. Its main limitation is that the data were gathered from families living in Bradford, and therefore may not be generalisable throughout the country. 

Active interventions aimed at reducing the spread of respiratory tract infections in household and childcare settings may reduce antibiotic prescribing, which will assist antimicrobial stewardship in primary care.

Lucille Kelsall-Knight is a lecturer in children’s nursing at University of Birmingham School of Nursing



  1. Miller, F et al. (2022) Factors predicting amoxicillin prescribing in primary care among children: a cohort study. BJGP; 2022;72(722):e659–67. DOI: 10.3399/BJGP.2021.0639. Link
  2. Sun X, Gulliford M. Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study. BMJ Open. 2019;9(7):e023989. DOI: 10.1136/bmjopen-2018-023989. Link
  3.  Schneider-Lindner V, Quach C, Hanley JA, Suissa S. Secular trends of antibacterial prescribing in UK paediatric primary care. J Antimicrob Chemother. 2010;66(2):424- 33. Link 
  4.  O’Brien K, Bellis TW, Kelson M, et al. Clinical predictors of antibiotic prescribing for acutely ill children in primary care: an observational study. BJGP. 2015;65(638):e585-92. Link
  5.  World Health Organization. Global Action Plan on Antimicrobial Resistance. 2016. Link


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