Non-Prescription Antibiotic Use for Cough Among Chinese Children Aged Under 5 Years: A Community-Based Cross-Sectional Study

Abstract Background: Cough is a common symptom in childhood and is an important circumstance of inappropriate antibiotic use. This study aimed to investigate the non-prescription use of antibiotics for cough among children aged under 5 years.Methods: We conducted a community-based survey of under-5 children in Yiwu, China from October to November 2019. The subjects were enrolled from 14 townships using a two-stage stratified sampling procedure. Detailed information was collected through a face-to-face interview based on a standard questionnaire, and the children’s caregivers answered as agents. Univariable and multivariable logistic regression analyses were performed to explore the factors associated with nonprescription use of antibiotics for cough in children. Results: A total of 3102 children were included in the study, and 1211 children were reported to have a cough in the past month. Among them, 40.2% (487/1211) were medicated with antibiotics, and 18.7% (91/487) of these were unprescribed. Cephalosporins were the most frequently used antibiotic (52.8%), and community pharmacies were the main source (53.7%). Children who coughed for 1–2 weeks (OR=1.73, 95% CI=1.03-2.90) or 3–4 weeks (OR=2.39, 95%CI=1.08-4.97), with 2 or more accompanying symptoms (OR=2.44, 95% CI=1.14-5.72), or with a family annual income between 50000 and 100000 RMB (OR=4.14, 95% CI=1.41-17.69) had a higher risk of non-prescription use of antibiotics than those coughing for <1 week, without accompanying symptoms, or with family annual income <50000 RMB.Conclusions: Our findings indicated that a high proportion of infants and young children had been treated with antibiotics for cough, and nearly 1/5 of them were used without prescription. More public health campaigns and further health teaching on the appropriate use of antibiotics are needed to ensure the rational treatment of cough in children.