Trends in antibiotic dispensing for children in Belgian ambulatory care: time series analysis before, during, and after the COVID-19 pandemic.

Objective: The aim of this study is to analyse trends in paediatric antibiotic use in Belgian ambulatory care across three COVID-19 pandemic-related periods. Methods: We conducted a retrospective time series analysis using autoregressive integrated moving average modelling. The analysis is based on anonymized pharmacy dispensing data for antibiotics delivered to Belgian children aged 0-12 years, retrieved from Farmanet for the period from 2014 until 2023. The outcome measures were the number of packages, expenditures and DDDs. Outcomes were analysed for all antibiotics collectively and for subgroups based on patient characteristics, prescriber specialty, geographic region and antibiotic characteristics. Results: Antibiotic use among children in Belgian ambulatory care sharply declined during the COVID-19 pandemic (-42.7%), followed by a gradual return to pre-pandemic levels (+66.9%), which was primarily driven by prescriptions of antibiotics commonly used for respiratory tract infections. The initial reduction exceeded expected seasonal variations. The largest decreases during the pandemic and subsequent increases were observed among children aged 7-12 years, those with standard reimbursement, in prescriptions by general practitioners and in rural areas of Flanders and the Walloon region. Conclusions: The COVID-19 pandemic significantly disrupted paediatric antibiotic prescribing patterns in Belgian ambulatory care. These findings highlight the importance of sustained antimicrobial stewardship efforts, not only in routine healthcare settings but also during periods of altered care delivery.