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Antibiotic use in children with asthma: cohort study in UK and Dutch primary care databases
Esmé J Baan1, Hettie M Janssens2, Tine Kerckaert3
1Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.
Insights
Antibiotic prescriptions are higher in children with asthma, often for conditions not typically requiring them. This overuse necessitates greater awareness to combat antibiotic resistance.
Area of Science:
- Pediatric pulmonology
- Infectious disease epidemiology
- Pharmacovigilance
Background:
- Asthma is a common chronic respiratory condition in children.
- Antibiotic stewardship is crucial to prevent antimicrobial resistance.
- Understanding prescription patterns in pediatric asthma is essential for optimizing care.
Purpose of the Study:
- To compare antibiotic prescription rates, indications, and drug types in children with and without asthma.
- To identify differences in antibiotic use patterns between asthmatic and non-asthmatic pediatric populations.
- To inform strategies for reducing unnecessary antibiotic prescriptions in children with asthma.
Main Methods:
- Retrospective cohort study utilizing two large, population-based primary care databases (IPCI and THIN).
- Inclusion of children aged 5-18 years from January 2000 to December 2014.
- Categorization of asthma status based on respiratory drug prescriptions and recorded asthma codes.
Main Results:
- Significantly higher antibiotic use in asthmatic children compared to non-asthmatic children across both databases.
- A notable proportion of antibiotic prescriptions in asthmatic children were for asthma exacerbations or lower respiratory tract infections, sometimes outside guideline recommendations.
- Antibiotic prescription rates per 1000 person-years were substantially higher in asthmatic children (e.g., THIN: 374 vs. 250).
Conclusions:
- Antibiotic use is elevated in children with asthma, frequently for conditions not aligned with current treatment guidelines.
- There is a need for increased physician and patient awareness regarding appropriate antibiotic use in pediatric asthma.
- Minimizing antibiotic overuse in this population is critical for limiting the development of antibiotic resistance.
Objectives:
To compare the rate, indications and type of antibiotic prescriptions in children with and without asthma.
Design:
A retrospective cohort study.
Setting:
Two population-based primary care databases: Integrated Primary Care Information database (IPCI; the Netherlands) and The Health Improvement Network (THIN; the UK).
Participants:
Children aged 5-18 years were included from January 2000 to December 2014. A child was categorised as having asthma if there were ≥2 prescriptions of respiratory drugs in the year following a code for asthma. Children were labelled as non-asthmatic if no asthma code was recorded in the patient file.
Main Outcome Measures:
Rate of antibiotic prescriptions, related indications and type of antibiotic drugs.
Results:
The cohorts in IPCI and THIN consisted of 946 143 and 7 241 271 person years (PY), respectively. In both cohorts, antibiotic use was significantly higher in asthmatic children (IPCI: 197vs126 users/1000 PY, THIN: 374vs250 users/1000 PY). In children with asthma, part of antibiotic prescriptions were for an asthma exacerbation only (IPCI: 14%, THIN: 4%) and prescriptions were more often due to lower respiratory tract infections then in non-asthmatic children (IPCI: 18%vs13%, THIN: 21%vs12%). Drug type and quality indicators depended more on age, gender and database than on asthma status.
Conclusions:
Use of antibiotics was higher in asthmatic children compared with non-asthmatic children. This was mostly due to diseases for which antibiotics are normally not indicated according to guidelines. Further awareness among physicians and patients is needed to minimise antibiotic overuse and limit antibiotic resistance.
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