OBJECTIVES: Systemic antibacterials are frequently used by children. We assessed trends in prevalence of antibacterial drug use among Dutch children from 2005 until 2010. METHODS: The PHARMO Record Linkage System, containing amongst others outpatient pharmacy dispensing data of ~3.2 million inhabitants in the Netherlands, was used for this study. For every year in the study period 2005-2010, the number of children aged 0-18 years with any dispensing of systemic antibacterials and per subtype was counted and extrapolated to the Netherlands, standardized for age and gender. Prevalence of use was reported per 10,000 children and was stratified by calendar year, age group (<2 years: infants and toddlers, 2-11 years: children, 12-18 years: adolescents) and gender. RESULTS: The prevalence of antibacterial drug use decreased 1.1-fold among infants and toddlers (from 2,231 to 2,041 per 10,000), decreased 1.3-fold among children (from 1,979 to 1,564 per 10,000), but remained constant among adolescents (1,193 per 10,000). A decrease of use was mainly observed in the most prevalent types; penicillins with extended spectrum and macrolides. However, also trimethoprim and derivatives were less frequently used, especially among female adolescents (from 163 to 92 per 10,000). Prevalence of beta-lactamase resistant penicillins increased from 2 to 29 per 10,000 among infants and toddlers and from 44 to 77 per 10,000 among children. An increase in nitrofuran derivatives was observed among female children (from 38 to 100 per 10,000) and female adolescents (from 267 to 413 per 10,000). CONCLUSIONS: This study provides an extensive overview of trends in antibacterial drug use among children in the Netherlands. An overall decrease of use was observed, while an increase was observed for nitrofuran derivatives and beta-lactamase resistant penicillins.