ABSTRACT
Aim
This study explores the trends in healthcare professionals' searches for children's oral suspension of antibiotics and antibiotic prescriptions, as well as COVID‐19 diagnoses in children under 5–6 years of age.
Methods
In Finland, Physician's Databases serve as a medical online source for healthcare professionals. Searches for seven oral suspensions of antibiotics (amoxicillin, amoxicillin/clavulanic acid, phenoxymethylpenicillin, cephalexin, azithromycin, clarithromycin and erythromycin) were analysed in 2017–2023, alongside children's antibiotic prescriptions from the Social Insurance Institution, as well as children's COVID‐19 diagnoses from the register of the Finnish Institute for Health and Welfare.
Results
There were 1 231 383 antibiotic searches, 492 407 antibiotic prescriptions and 42 293 diagnoses for COVID‐19 in children. Amoxicillin was searched most (498 276) with clear seasonal patterns, and the decrease appeared in searches and prescriptions during March 2020–August 2021. Amoxicillin searches also showed an increase with two major peaks during September 2021–August 2023.
Conclusion
Healthcare professionals' online information‐seeking for children's oral suspension of antibiotics showed a great decrease in searches after the start of COVID‐19 but rapidly increased 2 years later. Information‐seeking behaviour may be used to monitor the clinical use of antibiotics in children.
Keywords: anti‐bacterial agents, bacterial infections, COVID‐19, health personnel
Summary.
Healthcare professionals in Finland use Physician's Databases when seeking online information on antibiotic oral suspensions for children.
In 2017–2023, over 1,2 million antibiotic searches (mostly amoxicillin) were done, showing a decrease–increase pattern in searches and antibiotic prescriptions after the start of the COVID‐19 pandemic.
Online medical sources for professionals can be used in monitoring antibiotic usage and improving public health surveillance.
Abbreviations
- ATC
anatomical therapeutic chemical
- COVID‐19
Coronavirus disease
- HCPs
healthcare professionals
- ICD‐10
International Classification of Diseases, 10th Revision
- Kela
Social Insurance Institution of Finland
- PD
Physician's Databases
- THL
Finnish Institute for Health and Welfare
1. Introduction
Antibiotics are frequently prescribed for children's bacterial infections, such as pneumonia, otitis media and sinusitis [1, 2]. In paediatric care, amoxicillin or amoxicillin/clavulanic acid is predominantly used for otitis media [3, 4, 5, 6, 7], while sinusitis treatments often include amoxicillin, penicillin or macrolides [8, 9]. Oral suspensions are particularly favoured for children due to their ease of dosage adjustment based on weight or age. However, inappropriate antibiotic use—especially for viral infections—remains a concern, contributing to antibiotic resistance and adverse outcomes [10].
The COVID‐19 pandemic, which began in early 2020 [11], introduced public health measures, such as mask mandates, social distancing and hand hygiene campaigns. These interventions significantly reduced viral respiratory infections, including childhood otitis media [12, 13, 14, 15]. By late 2022, the Finnish Institute for Health and Welfare (THL) classified COVID‐19 as a flu‐like infection [16], signalling a shift in its public health impact.
While some studies report the reduced antibiotic prescriptions and otitis media diagnoses during the pandemic [17, 18], others highlight the increased empirical prescribing linked to concerns about bacterial co‐infections [19, 20]. After the lifting of the COVID‐19 restrictions, there has been a notable increase in acute mastoiditis diagnoses arising from acute otitis media [21]. In Finland, HCPs rely on Physician's Databases (PD), an online medical source providing comprehensive guidelines and pharmaceutical information [22]. Prior research has shown that PD search activity has correlated with clinical trends, such as influenza diagnoses [23]. Despite these insights, little is known about how HCPs' searches for children's antibiotic information have evolved during the pandemic.
This study aimed to evaluate HCPs' search behaviour in the dedicated online databases in assessing children's oral suspension of antibiotics and its association with antibiotic prescriptions in Finland. We also investigated the trends in searches for amoxicillin and amoxicillin/clavulanic acid in 2017–2023, examining how the trends aligned with the prescriptions before, during and after the COVID‐19 pandemic.
2. Methods
2.1. Study Design
This retrospective observational study analysed log data from PD to explore the trends in HCPs' searches for oral suspension of antibiotics in Finland from 2017 to 2023. The study also incorporated prescription data and clinical COVID‐19 diagnosis records to identify the associations between information‐seeking behaviour, prescribing patterns and diagnoses.
2.2. Data Sources
We analysed weekly search logs from PD (2017–2023). Since there is a specific online page for each form of a certain antibiotic in PD, it was therefore possible to focus on oral suspensions. The antibiotics included were amoxicillin (50 mg/mL, 100 mg/mL), amoxicillin/clavulanic acid (50/12.5 mg/mL, 80/11.4 mg/mL), phenoxymethylpenicillin (50 mg/mL), cephalexin (50 mg/mL, 100 mg/mL), azithromycin (40 mg/mL), clarithromycin (50 mg/mL) and erythromycin (400 mg/5 mL). Weekly searches for each antibiotic were aggregated and tabulated.
Annual antibiotic prescription data for children aged 0–5 years (2019–2023) were obtained from the Kela Info Tray, maintained by the Social Insurance Institution of Finland. Prescriptions were categorised using Anatomical Therapeutic Chemical (ATC) classifications, including J01CA04 (amoxicillin), J01CE02 (phenoxymethylpenicillin), J01CR02 (amoxicillin/clavulanic acid), J01DB01 (cephalexin), J01FA01 (erythromycin), J01FA09 (clarithromycin) and J01FA10 (azithromycin). Only prescriptions eligible for National Health Insurance reimbursement were included. These data did not distinguish between oral suspensions and tablet forms of the antibiotic. However, oral suspensions are typically given to children in this age group.
Annual diagnoses of COVID‐19 (ICD‐10 U07) among children aged 0–6 years (2018–2023) were obtained from the Finnish Institute for Health and Welfare (THL).
2.3. Data Analysis
Weekly search trends were visualised and compared with annual prescription and diagnosis data to identify seasonal patterns, anomalies and the potential impact of the COVID‐19 pandemic. Data were visualised using MS Excel.
2.4. Ethics
The data analysed in this study were anonymised and publicly available through the Kela Info Tray, PD and THL open data. PD data is anonymous and not publicly available. Ethical approval was not required or applied for as no identifiable patient information was used.
3. Results
This study aimed to assess the trends in HCPs' searches for children's oral suspension of antibiotics and antibiotic prescriptions, as well as COVID‐19 diagnoses under 5–6‐year‐old children. Quantitative analysis showed that there were 1 231 383 antibiotic searches for all seven antibiotics (Table 1), and most searches appeared in amoxicillin (498 276) and amoxicillin/clavulanic acid (245 753). Analysis identified seasonal fluctuations in antibiotic search patterns, with winter months showing markedly higher search volumes for amoxicillin, amoxicillin/clavulanic acid, phenoxymethylpenicillin and azithromycin compared to other seasons (Figure 1). In other antibiotics, there were no seasonal changes. These seasonal antibiotic searches also decreased dramatically after the start of the COVID‐19 pandemic when the Declaration of the Emergency Powers Act and the Communicable Diseases Act were stated in Finland in March 2020.
TABLE 1.
Oral suspension of antibiotic searches in Physician's Databases in 2017–2023.
| Year | Number of searches for oral suspension of antibiotics | ||||||
|---|---|---|---|---|---|---|---|
| Amoxicillin | Amoxicillin/clavulanic acid | Phenoxymethyl‐penicillin | Cephalexin | Macrolides | |||
| Azithromycin | Clarithromycin | Erythromycin | |||||
| 2017 | 83 516 | 32 967 | 21 482 | 47 081 | 16 453 | 4716 | 1617 |
| 2018 | 83 163 | 35 545 | 21 200 | 51 524 | 13 748 | 3870 | 1966 |
| 2019 | 80 595 | 37 446 | 21 408 | 44 275 | 13 161 | 2712 | 1192 |
| 2020 | 39 472 | 21 990 | 10 844 | 31 360 | 6376 | 1353 | 933 |
| 2021 | 48 688 | 30 173 | 7199 | 29 200 | 7241 | 1180 | 1111 |
| 2022 | 95 416 | 52 471 | 10 374 | 35 494 | 14 375 | 1898 | 1182 |
| 1–7/2023 | 67 426 | 35 161 | 18 541 | 31 897 | 8833 | 1003 | 555 |
| 2017–7/2023 | 498 276 | 245 753 | 111 048 | 270 831 | 80 187 | 16 732 | 8556 |
Note: Years with the highest number of prescriptions are shown in red, while those with lowest numbers are shown in blue.
FIGURE 1.
Oral suspension of antibiotic searches in Physician's Databases in 2017–2023.
492 407 antibiotic prescriptions (0–5 years old children) could be found for all seven antibiotics in 2019–2023 (Table 2). The searches and prescriptions for amoxicillin and amoxicillin/clavulanic acid followed a similar seasonal and annual pattern (Figures 1 and 2). In 2017–2023, there were altogether 300 467 prescriptions and 498 276 information searches for amoxicillin. In 2020, there were 39 461 amoxicillin prescriptions and 39 472 amoxicillin searches, whereas in 2022, there were 86 846 amoxicillin prescriptions and 95 416 amoxicillin searches. At the end of 2022, there was a rapid increase in amoxicillin and amoxicillin/clavulanic acid searches. In azithromycin, the number of searches was doubled from 2020 to 2022 at the same time as the number of prescriptions. When looking at less‐commonly used antibiotics, information searches occur significantly more in relation to the number of prescriptions written (Tables 1 and 2).
TABLE 2.
Number of antibiotic prescriptions (age 0–5 years) in Finland 2019–2023.
| Number of prescriptions (age 0–5 years) | |||||||
|---|---|---|---|---|---|---|---|
| Year | Number of prescriptions (age 0–5 years) | ||||||
| Amoxicillin | Amoxicillin/clavulanic acid | Phenoxymethyl‐penicillin | Cephalexin | Macrolides | |||
| Azithromycin | Clarithromycin | Erythromycin | |||||
| 2019 | 91 287 | 35 442 | 461 | 384 | 11 501 | 900 | 0 |
| 2020 | 39 461 | 14 818 | 166 | 185 | 4552 | 283 | 0 |
| 2021 | 53 044 | 23 037 | 0 | 139 | 5838 | 389 | 0 |
| 2022 | 86 846 | 38 739 | 0 | 134 | 8927 | 660 | 0 |
| 2023 | 82 873 | 36 962 | 0 | 256 | 7813 | 354 | 0 |
| 2019–2023 | 300 467 | 148 998 | 627 | 1098 | 38 631 | 2586 | 0 |
Note: Years with the highest numbers of prescriptions are shown in red, while those with the lowest numbers are shown in blue.
FIGURE 2.
Number of amoxicillin and amoxicillin/clavulanic acid quarterly‐year prescriptions (age 0–5 years) and oral suspension of antibiotic searches in Physician's Databases, as well as yearly COVID‐19 diagnoses (age 0–6 years) in Finland 2019–2023.
In 2020–2021, COVID‐19 diagnoses showed a rapid increase with a major peak of 22 292 diagnoses in 2021, but decreased in 2022–2023 (Figure 2, Table 3). A total of 42 293 COVID‐19 diagnoses in children were found from 2020 to 2023. Two major peaks of article searches and prescriptions for amoxicillin and amoxicillin/clavulanic acid occurred in 2021 and 2023. Interestingly, the second peak appeared during the rapid decrease in COVID‐19 diagnoses in 2022–2023 (Figure 2).
TABLE 3.
Number of children's (age 0–6 years) otitis media and COVID‐19 diagnoses in Finland 2018–2023.
| Year | Number of COVID‐19 diagnoses (ICD‐10 code U07) (age 0–6) |
|---|---|
| 2018 | 0 |
| 2019 | 6 |
| 2020 | 7443 |
| 2021 | 22 292 |
| 2022 | 11 512 |
| 2023 | 1040 |
| 2018–2023 | 42 293 |
4. Discussion
Our study describes healthcare professionals' search behaviour for antibiotics and its visual association with prescription trends in Finland from 2017 to 2023. The findings highlight the influence of external factors, such as the COVID‐19 pandemic and policy changes, on both antibiotic use and information‐seeking patterns. Monitoring information‐seeking behaviour in the dedicated online databases can offer a novel, real‐time method for tracking antibiotic consumption with its possible relation to detecting infectious disease epidemics. This aligns with similar findings from our previous study of using online searches of children's oseltamivir in detecting influenza outbreaks in Finland [23], thus supporting the potential of search data as a supplementary tool for public health surveillance.
An additional insight from the log data is the persistent information‐seeking behaviour related to less‐commonly used antibiotics. For instance, HCPs searched for information on macrolides (such as azithromycin and clarithromycin) at a disproportionately higher rate relative to the number of prescriptions. This suggests a greater need for accessible and updated knowledge about these less‐frequently prescribed antibiotics, which are often used in more specific or complex clinical scenarios.
Cephalexin searches demonstrated smaller fluctuations compared to other antibiotics, likely due to its indication for non‐respiratory infections, such as skin infections, which may not have declined significantly during the pandemic. This suggests that the type of infections targeted by a specific antibiotic plays a role in its usage trends, even during periods of reduced overall infection rates.
Overall, our findings illustrate the dynamic relationship between antibiotic prescribing, search behaviour and external factors such as pandemics and policy changes. While prescription trends and searches often align, discrepancies highlight the complex interplay between clinical needs, policy and professional education in shaping healthcare practices.
The impact of the COVID‐19 pandemic was evident in the data. From 2017 to 2019, search volumes for antibiotics remained relatively stable. However, by 2020, searches for all antibiotics dropped sharply, coinciding with the reduced incidence of infections during the pandemic [24]. Following the easing of COVID‐19 restrictions, both prescription volumes and search activity for antibiotics increased significantly, reflecting a return to pre‐pandemic levels of infection and even a significant increase. Interestingly, we observed that search activity for antibiotics does not always associate directly with prescription trends. This finding suggests that multiple factors—beyond immediate clinical prescribing needs—may influence information‐seeking behaviour. These factors could include changes in guidelines, emerging concerns about resistance, or even marketing efforts among healthcare providers.
There are some limitations to this study. Prescription data were available only from 2019, reflecting the adoption of digital prescriptions in Finland. One key observation is the discontinuation of reimbursement for phenoxymethylpenicillin, which resulted in its absence from the Kela dataset after 2020. This limitation demonstrates the challenges associated with utilising administrative datasets, as reimbursement policies and data availability directly impact the comprehensiveness and reliability of research findings. Our results reflect these constraints, emphasising the need for caution when interpreting data from one source only.
To obtain a comprehensive and accurate representation of healthcare practices, future studies should integrate multiple datasets, leveraging their complementary strengths. Artificial intelligence presents an exciting opportunity in this regard, enabling the synthesis of diverse data sources with interpretation in real time. However, more rigorous scientific research is needed to better understand the limitations and risks associated with various datasets. This dual approach will help enhance the reliability of data‐driven insights and inform evidence‐based decision‐making in healthcare.
5. Conclusion
This study has found that healthcare professionals' online information‐seeking for children's oral suspension of antibiotics showed a great decrease in searches after the start of COVID‐19 but rapidly increased 2 years later. Online medical sources aimed at professionals can be used in monitoring antibiotic usage and improving public health surveillance.
Author Contributions
Milla Mukka: conceptualization, project administration, methodology, data curation, formal analysis, writing – original draft, writing – review and editing. Otto Helve: conceptualization, supervision, project administration, methodology, data curation, formal analysis, writing – review and editing. Pekka Mustonen: conceptualization, project administration, methodology, writing – review and editing. Minna Kaila: conceptualization, supervision, project administration, methodology, writing – review and editing. Samuli Pesälä: conceptualization, supervision, project administration, methodology, data curation, formal analysis, writing – original draft, writing – review and editing.
Conflicts of Interest
Minna Kaila has held various trustee positions in the Finnish Medical Society Duodecim since the late 1990s. Otto Helve has held various trustee positions in the Finnish Medical Society Duodecim and Duodecim Medical Publications Ltd. since 2009 and is a partner at iHealth Finland Ltd. The other authors have no conflicts of interest.
Acknowledgements
The authors would like to acknowledge Jari Hakkola who took part in data collection. Open access publishing facilitated by Helsingin yliopisto, as part of the Wiley ‐ FinELib agreement.
Funding: The authors received no specific funding for this work.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.