Macrolide prescription in Dutch children: compliance with guidelines

  • Rosa A. M. BandellEmail author
  • Tanja Dekkers
  • Bernardus A. Semmekrot
  • Saskia N. de Wildt
  • Hanneke W. H. A. Fleuren
  • Margaretha F. Warlé-van Herwaarden
  • Peter Füssenich
  • Gerardus P. Gerrits
  • Cornelis Kramers
Original Article


For reasons of antibiotic resistance and side effects, macrolides should be prescribed with care in the pediatric population. We evaluated the adherence to Dutch guidelines of macrolide prescription in children and estimated the risk of Mycoplasma pneumoniae–associated pneumonia based on Fischer’s decision tree. In this retrospective study, we included children aged 0–18 years who were treated with azithromycin or clarithromycin for pulmonary disease in four settings from general practice to hospital ward for (1) the prescriptions not in accordance with the guideline of the Dutch Association of Pediatrics and (2) the risk of M. pneumoniae in patients with community-acquired pneumonia (CAP) according to Fischer’s decision tree. The latter suggests that children older than three years with a fever lasting more than two days are at high risk for M. pneumoniae and that it is therefore justified to treat them with macrolides. In total, 189 macrolide prescriptions from 2015 until 2017 were analyzed: 139 children used macrolides for a pulmonary indication (75%); 18% (n = 25) of the prescriptions were not in accordance with Dutch guidelines. Only 9.1% of patients with CAP were classified as having a high risk of M. pneumoniae according to Fischer’s decision tree. A significant proportion of macrolide prescriptions for Dutch children with a pulmonary disease appears not to be in accordance with the guidelines. Most patients with CAP treated with a macrolide actually had a low risk of having M. pneumoniae according to Fischer’s decision tree. Both observations suggest overuse of macrolides in children.


Microbiology Respiratory disorders Pharmacology Infectious disease medicine 



  • Dr. E.A. Croonen (Radboudumc, Department of Pediatrics, Nijmegen, The Netherlands, and Canisius Wilhelmina Hospital, Department of Pediatrics, Nijmegen, The Netherlands)

  • Mrs. J.C. Zoet-Verheul (Canisius Wilhelmina Hospital, Department of Pediatrics, Nijmegen, The Netherlands)

  • Mrs. M.W.R.G. Lennertz (Canisius Wilhelmina Hospital, Department of Outpatient Pharmacy, Nijmegen, The Netherlands)

  • Mr. J. Maliepaard (Pharmacy Nijmegen, The Netherlands)

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The regional Medical Ethical Committee Nijmegen-Arnhem waived the need for ethical approval, according to the Dutch Medical Research Involving Human Subjects Acts, as only patient chart data were collected.

Informed consent

No informed consent was required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Rosa A. M. Bandell
    • 1
    • 2
    Email author
  • Tanja Dekkers
    • 3
  • Bernardus A. Semmekrot
    • 1
  • Saskia N. de Wildt
    • 4
    • 5
  • Hanneke W. H. A. Fleuren
    • 2
  • Margaretha F. Warlé-van Herwaarden
    • 6
  • Peter Füssenich
    • 7
  • Gerardus P. Gerrits
    • 1
  • Cornelis Kramers
    • 2
    • 4
  1. 1.Department of PediatricsCanisius Wilhelmina HospitalNijmegenThe Netherlands
  2. 2.Department of Clinical PharmacyCanisius Wilhelmina HospitalNijmegenThe Netherlands
  3. 3.Department of Internal MedicineRadboudumcNijmegenThe Netherlands
  4. 4.Department of Pharmacology-ToxicologyRadboudumcNijmegenThe Netherlands
  5. 5.Intensive Care and Department of Pediatric SurgeryErasmus MC SophiaRotterdamThe Netherlands
  6. 6.Community PharmacyGroesbeekThe Netherlands
  7. 7.General PracticeGroesbeekThe Netherlands

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