Effect of Antibiotics in Preventing Hospitalizations From Respiratory Tract Infections in Children With Down Syndrome

Abstract

To determine the impact of antibiotic prescription for respiratory tract infections (RTIs) on the subsequent risk of RTI-related hospitalizations in children with Down syndrome (DS).Children aged ≤18 years (defined in groups: 0–1 years; 1–5 years; 5–10 years; and 10–18 years), with DS (as identified by Read and International Statistical Classification of Diseases and Related Health Problems 10th Revision, codes) were included. Each child with DS in the cohort were frequency matched by general practitioner (GP), sex, birth year (+/− 5 years), and start of follow-up age ≤18 years (follow-up was defined as a period of 28 days from the initial RTI-related GP consultation or until the first RTI-related hospitalization).Information regarding health care use was extrapolated from Clinical Disease Research Using Linked Bespoke Studies and Electronic Health Records, an electronic health records database in the United Kingdom, on the basis of Read and International Statistical Classification of Diseases and Related Health Problems 10th Revision, codes, to classify types of RTIs (lower respiratory tract infection; upper respiratory tract infection; unclassified) and probable versus possible RTI, identify diagnosis of DS and other comorbidities, and determine admission and discharge dates. Extracted data were reviewed and confirmed by a committee of clinicians and academic professionals. Logistic regression models were used to assess the impact of antibiotic prescriptions on the risk of subsequent RTI-related hospitalization in DS patients with RTI-related GP consultations. In subgroup analyses, the researchers further explored the effect of antibiotics across different age groups and type of RTI.Both cohorts (DS: 992; control: 4874) had similar demographic characteristics for sex and age. There were more White individuals in the group with DS versus in the control group (58.5% vs 41.8%) and more comorbidities in the group with DS. Antibiotic prescriptions after an RTI-related GP consultation did not significantly reduce the risk of the 28-day RTI-related hospitalization for either group, even after adjusting for antibiotic prescription, age group, sex, presence of congenital heart disease, presence of asthma, and number of previous RTI-related hospitalizations and RTI-related GP consultations in the previous 6 months. When adjusted for the same covariates, RTI-related hospitalizations were significantly reduced in DS individuals aged 0–1 years who were prescribed antibiotics for RTI-related concerns (adjusted odds ratio: 0.260; 95% confidence interval: 0.077 to 0.876) but not in other age groups. This protective effect was also not seen by type of RTI or in the control group.Aside from infants aged 0 to 1 years with DS, antibiotic prescriptions did not reduce RTI-related hospitalizations.It appears that children with DS are frequently prescribed antibiotics for viral infections in the United Kingdom. Although antibiotics have not been shown to reduce hospitalizations for RTI in the general pediatric population, in previous studies, researchers did not include children with comorbidities, prompting these authors to specifically examine children with DS. It is unclear how antibiotic prescribing behavior for this special population compares between the United Kingdom and the United States, thus limiting the generalizability of these results. Nevertheless, the authors surmise that nonantibiotic interventions to manage RTIs in medically complex children can be effective, which is consistent with our outpatient stewardship efforts to combat antibiotic misuse and resistance in the United States.