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Rates and determinants of antibiotics and probiotics prescription to children in Asia-Pacific countries
J Zhang1, D Cameron2, S H Quak3
1The Children's Hospital, School of Medicine, Zhejiang University, 3333 Binsheng Road, 310052 Hangzhou, Zhejiang, China P.R.
Insights
Antibiotic-associated diarrhea (AAD) is a concern, yet probiotic co-prescription with antibiotics in Asia-Pacific children is low and varies significantly by country. Physician awareness of probiotics
Area of Science:
- Microbiology and Infectious Diseases
- Pediatric Gastroenterology
- Public Health and Epidemiology
Background:
- Antibiotic therapy can cause side effects like antibiotic-associated diarrhea (AAD).
- Guidelines recommend probiotics to mitigate AAD risk in children.
- Data on antibiotic and probiotic co-prescription patterns in the diverse Asia-Pacific region are limited.
Purpose of the Study:
- To investigate the rates and determinants of antibiotic and probiotic co-prescription in children across seven Asia-Pacific countries.
- To understand physician prescribing habits and influencing factors for antibiotics and probiotics.
Main Methods:
- A cross-sectional survey was conducted among 731 general practitioners and pediatricians in Australia, Japan, Indonesia, India, China, Singapore, and South Korea.
- An online questionnaire assessed prescribing practices and reasons for antibiotic and probiotic use.
Main Results:
- Antibiotics were prescribed in 37% of pediatric consultations, with significant country-level variation (17% in Australia to 47% in India).
- While 84% of physicians acknowledged antibiotic disruption of gut microbiota and 68% viewed probiotics as effective for AAD prevention, only 33% co-prescribed probiotics.
- Key reasons for probiotic co-prescription included prior AAD episodes, current diarrhea, and specific antibiotic types (amoxicillin-clavulanic acid, prolonged courses).
Conclusions:
- Significant disparities exist in antibiotic and probiotic co-prescription rates across Asia-Pacific countries, influenced by cultural and organizational factors.
- Despite awareness of AAD risks and probiotic benefits, co-prescription rates remain suboptimal.
- Further research is needed to address country-specific barriers to guideline adherence for probiotic use in pediatric antibiotic therapy.
Abstract:
Antibiotic therapy may have important side effects. Guidelines recommend the administration of specific probiotics to reduce the risk of antibiotic-associated diarrhoea (AAD). The rates and determinants of antibiotics and co-prescription of probiotics in children remain poorly known in Asia-Pacific countries, which are very heterogenous in terms of economic development, health care organization and health policies. A survey among general practitioners (GPs) and paediatricians was performed in seven countries of the Asia-Pacific area (Australia, Japan, Indonesia, India, China, Singapore, and South Korea). Physicians completed an online questionnaire that explored their current habits and the determinants for prescribing antibiotics and probiotics. For the 731 physicians who completed the questionnaire (390 paediatricians and 341 GPs), 37% of all consultations for a child led to the prescription of antibiotics (ranging from 17% in Australia to 47% in India). A large majority of physicians (84%) agreed that antibiotics disrupted gut microbiota and considered probiotics an effective intervention to prevent AAD (68%). However, only 33% co-prescribed probiotics with antibiotics (ranging from 13% in Japan to 60% in South Korea). The main reasons for prescribing probiotics were previous episodes of AAD (61%), presence of diarrhoea (55%), prolonged antibiotic treatment (54%) or amoxicillin-clavulanic acid therapy (54%). Although current local guidelines recommend the use of selected probiotics in children receiving antibiotics in Asia-Pacific area, the rates of antibiotics and probiotics prescription significantly vary among countries and are deeply affected by country-related cultural and organisational issues.
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