Influence of Day Care Attendance on the Use of Systemic Antibiotics in 0- to 2-Year-Old Children

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Abstract
Objective. To examine the association between time spent in different public day care settings and prescription of systemic antibiotics. Design. Population-based cohort study of 5035 Danish children born in 1997 followed from birth to June 30, 1999. Methods. The study was performed by the linkage of records drawn from administrative registries. Exposure was the total time spent in a day care home or day care center. Outcome was the first prescription of a systemic antibiotic. Possible perinatal and sociodemographic confounding factors were considered by statistical analysis. Results. During the first year of life, 39.8% of the girls and 51.1% of the boys received at least 1 antibiotic prescription drug. Enrollment in a day care setting doubled a child's risk of receiving a prescription drug (adjusted relative risk in day care home 1.9, 95% confidence interval: 1.7–2.0; adjusted relative risk in day care center 2.0, 95% confidence interval: 1.7–2.3). Only age confounded the analyses. Age >1 year at the starting time in day care reduced the risk of receiving antibiotic prescriptions during the first 3 months after enrollment. Conclusions. Enrollment in public day care facilities raised the risk of receiving an antibiotic prescription drug to the same extent in day care homes as well as in day care centers, so we cannot recommend one facility over the other based on the present study. Children <1 year old at enrollment were most at risk, suggesting that extension of parental leave may reduce the use of antibiotics.