Electronically Monitored Adherence to Short-Term Antibiotic Therapy in Children

Nonadherence to short-term antibiotic treatment in children can lead to treatment failure and the development of drug-resistant microorganisms. We aimed to provide reliable adherence estimates in this population.

A prospective, blinded, electronically monitored, observational study between January 2018 and October 2021. Patients aged 2 months to 5 years diagnosed with an acute bacterial infection requiring short-term (5-10 days) oral antibiotic monotherapy, were provided with an electronically monitored medication bottle, recording every manipulation of the cap. Primary outcomes were overall adherence, predefined as administration of >75% of doses relative to the number of doses prescribed, and timing adherence, defined as the administration of >75% of prescribed doses taken within ±20% of the prescribed interval.

One hundred infants (49 boys, mean [range] age 1.87 years [0.2-5.1]) were included in the final analysis. Only 11 participants received all the recommended doses. Overall adherence was 62%, whereas timing adherence was 21%. After applying a logistic regression model, the only factor significantly associated with nonadherence was being a single parent (odds ratio = 5.7; 95% confidence interval [1.07-30.3]). Prescribers overestimated adherence, defining 49 of 62 (77.7%) participants as likely adherent. Patients predicted to be adherent were not more likely to be adherent than those predicted to be nonadherent (31/47 actual adherence among those predicted to be adherent vs 6/16, P = .77).

Adherence of children to the short-term antimicrobial treatment of an acute infection is suboptimal. Providers were unable to predict the adherence of their patients. These data are important when considering recommended treatment durations and developing interventional programs to increase adherence.