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Objectives To analyse trends in reported antibiotic use for children aged &amp;lt;5 years with fever, diarrhoea or cough with fast or difficult breathing (outcome) from low- and middle-income countries (LMICs) during 2005–17, disaggregated by the following user characteristics: rural/urban residence, maternal education, household wealth and healthcare source visited. Methods Based on 132 Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 73 LMICs, the outcome, disaggregated by user characteristics for all country-years was estimated using a hierarchical Bayesian linear regression model. Results Across LMICs during 2005–17, the greatest relative increases in the outcome occurred in rural areas, poorest quintiles and least educated populations, particularly in low-income countries and South-East Asia. In low-income countries, rural areas had a 72% relative increase from 17.8% [uncertainty interval (UI): 5.2%–44.9%] in 2005 to 30.6% (11.7%–62.1%) in 2017, compared with a 29% relative increase in urban areas from 27.1% (8.7%–58.2%) in 2005 to 34.9% (13.3%–67.3%) in 2017. Despite these increases, the outcome was consistently highest in urban areas, wealthiest quintiles, and populations with the highest maternal education. Conclusions These estimates suggest that the increasing reported antibiotic use for sick children aged &amp;lt;5 years in LMICs during 2005–17 was driven by gains among groups often underserved by formal health services.

P49 Determinants of trends in reported antibiotic use for sick children from LMICs (2005–17): analysis of 132 national surveys from 73 countries