Scientific group Epi-Phare (created by health authorities ANSM and CNAM) and research institute Inserm (National Institute of Health and Medical Research) published the warning in a scientific journal The Lancet Regional Health – Europe.
Using data from the national health system, including 14,510,023 children residing in France, the researchers measured the frequency of pediatric prescriptions from general practitioners, dentists and midwives. They found that 86% of children under the age of 18 had received at least one prescription medication in 2018-19.
This percentage rose to 97% for children under six.
Pain relievers, especially paracetamol, were the most prescribed type of medication, followed by antibiotics, nasal steroids, nonsteroidal anti-inflammatory drugs, antihistamines, and oral steroids.
Half of the children under two had taken more than nine medications per year.
Steroids and antibiotics, in particular, are administered far too routinely, according to the article.
Antibiotics, steroids, and anti-reflux medications
The researchers have identified three categories of drugs for which they believe the prescription levels do not match the levels of the disease they are supposed to treat.
These are antibiotics, steroids, and drugs for esophageal reflux disease called proton pump inhibitors (PPIs).
The study showed that 40% of children are exposed to antibiotic treatment each year, which could lead to unnecessary antibiotic resistance.
Dr Marion Taine, epidemiologist at GIS Epi-Phare and lead author of the study, said: “Even though prescriptions have fallen by 12% over the past ten years, the use of antibiotics is much more common in the past. France than countries with equally efficient health systems.
“The Netherlands gives five times less antibiotics [than France], ” she said. Antibiotics are useless against viruses, which cause the majority of winter complaints.
These anti-inflammatory drugs may make an undetected bacterial infection worse, especially when taken by mouth. To avoid this, they should be prescribed for very specific cases, such as severe asthma.
Still, they’re often misused to treat minor ear, nose and throat infections in children aged six and under, according to the study.
They are particularly misused as a nasal decongestant, the authors said.
French doctors are five times more likely to prescribe steroids than American doctors, and 20 times more likely than Norwegian doctors.
Dr Taine said: “Their combined prescription in different forms (oral, nasal, inhaled, cream) exposes [patients] the risks of adrenal insufficiency in particular, and the long-term consequences of repeated use in young children are not known.
Medication for reflux
The third category includes drugs for esophageal reflux, called proton pump inhibitors (PPIs).
These are especially over-prescribed for infants, according to the study. Dr Taine said: “These treatments are not recommended and are only tolerated in certain cases, such as babies under one year of age, as they are suspected of causing unwanted side effects, including bone fractures. “
Prescriptions of this type of drug for infants have doubled in France over the past 10 years, according to the figures.
A cultural choice
Overall, the number of drugs prescribed is stable in France, according to the study.
This despite several campaigns to reduce the number of tablets and syrups given to children, as shown by recommendations to reduce antibiotic prescriptions and to ban cough syrups for children under two years of age.
Dr Fabienne Kochert, pediatrician in Orléans (Center-Val-de-Loire), sought to explain why French prescription levels differ so much from other countries. She suggested that this could be because most children are seen by a general practitioner rather than a specialist pediatrician.
She said Le Figaro: “We know that the more a doctor is trained in the specifics of early childhood, the less he tends to prescribe. But 80% of children are seen in consultation by general practitioners.
Dr Julie Chastang, from the general practitioner child service of the College of General Medicine, and general practitioner from Champigny-sur-Marne (Ile-de-France), said that overprescribing for children is more of a “ cultural choice ”, rather than a sign of difficulties within the French health system.
She said: “Doctors are getting mixed messages about antibiotics. Unlike other countries like Italy, the Netherlands and the United States, the French health authorities, for example, suggest the systematic use of antibiotics for acute middle ear problems in children under the age of two years.
“To treat recurring baby crying, we should be offering home support rather than PPIs. There is very little parental support in France.
Lead author of the study, Dr Taine, concluded that it is very important for the country to better understand the prescribing habits of general practitioners.
She said: “Today, the safety profiles of several drugs used in pediatrics are still only partially known. Therefore, the prescriptions must be reasonable.
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