Use of antibiotics in children younger than two years in eight countries: a prospective cohort study.

Elizabeth T Rogawski ,Manjeswori Ulak,Zulfiqar A Bhutta,Michael Gottlieb,Tahmeed Ahmed,Sajid Bashir Soofi,James A Platts-Mills,Mustafa Mahfuz,Estomih Mduma,Erling Svensen,Gagandeep Kang,Sanjaya Shrestha ,Pascal Bessong ,Eric R Houpt ,Anita K M Zaidi ,Jessica C Seidman ,Pablo Peñataro Yori ,Sushil Mathew John ,Dennis Lang ,Margaret Kosek ,Aldo A M Lima ,Richard L Guerrant

doi:10.2471/blt.16.176123

Abstract

ObjectiveTo describe the frequency and factors associated with antibiotic use in early childhood, and estimate the proportion of diarrhoea and respiratory illnesses episodes treated with antibiotics.MethodsBetween 2009 and 2014, we followed 2134 children from eight sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa and the United Republic of Tanzania, enrolled in the MAL-ED birth cohort study. We documented all antibiotic use from mothers’ reports at twice-weekly visits over the children’s first two years of life. We estimated the incidence of antibiotic use and the associations of antibiotic use with child and household characteristics. We described treatment patterns for diarrhoea and respiratory illnesses, and identified factors associated with treatment and antibiotic class.FindingsOver 1 346 388 total days of observation, 16 913 courses of antibiotics were recorded (an incidence of 4.9 courses per child per year), with the highest use in South Asia. Antibiotic treatment was given for 375/499 (75.2%) episodes of bloody diarrhoea and for 4274/9661 (44.2%) episodes of diarrhoea without bloody stools. Antibiotics were used in 2384/3943 (60.5%) episodes of fieldworker-confirmed acute lower respiratory tract illness as well as in 6608/16742 (39.5%) episodes of upper respiratory illness. Penicillins were used most frequently for respiratory illness, while antibiotic classes for diarrhoea treatment varied within and between sites.ConclusionRepeated antibiotic exposure was common early in life, and treatment of non-bloody diarrhoea and non-specific respiratory illnesses was not consistent with international recommendations. Rational antibiotic use programmes may have the most impact in South Asia, where antibiotic use was highest.

Highlights

Antibiotics can be a lifesaving treatment for children with bacterial infections and are the most commonly prescribed therapy among all medications given to children.[1]
We aimed to describe the frequency of antibiotic use by children in the first two years of life; determine the characteristics associated with antibiotic use; and estimate the proportions of diarrhoea and respiratory illness episodes treated with antibiotics, as reported by mothers in the MAL-ED study
We described the frequency of treatment for diarrhoea and respiratory illnesses

Summary

Introduction

Antibiotics can be a lifesaving treatment for children with bacterial infections and are the most commonly prescribed therapy among all medications given to children.[1] antibiotics can result in adverse events, drug toxicity and detrimental effects on the gut microbiota[2,3] and enteric immune system.[4,5] both at the individual and population levels, antibiotic overuse drives the development and transmission of antimicrobial resistance.[1,6] International guidelines for the treatment of childhood illnesses recommend antibiotic treatment for diarrhoea with bloody stools and for acute lower respiratory tract infections, but not for non-bloody diarrhoea and for upper respiratory infections.[7,8] Interventions to promote rational antibiotic use are critical for preserving the effectiveness of available drugs.[9,10,11] in low-resource settings, the high burden of bacterial causes of diarrhoea in children[12,13] has led to proposals for antibiotics to be used more widely for the treatment of diarrhoea even in the absence of dysentery.[14,15,16] Antibiotics may be a potential intervention for malnutrition and environmental enteropathy.[17]

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