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Published on: August 30, 2018
Inappropriate prescribing contributes to high antibiotic exposure in young children in Australia
Stejara A Netea1,2, Nicole L Messina1,3, Kaya Gardiner1,4
1Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia.
Insights
Antibiotic exposure is common in young children, with two-thirds receiving prescriptions within two years. Over a quarter of these antibiotic uses may have been unnecessary, raising concerns about resistance and long-term health.
Area of Science:
- Pediatric Health
- Antimicrobial Stewardship
- Public Health
Background:
- Antibiotic exposure in early life is linked to increased antimicrobial resistance and potential long-term health issues like allergies and weight gain.
- Understanding patterns of antibiotic use in infants is crucial for mitigating these risks.
Purpose of the Study:
- To assess antibiotic exposure in Australian children during their first two years of life.
- To identify factors influencing antibiotic prescription.
- To evaluate the appropriateness of antibiotic use.
Main Methods:
- Analysis of data from 1201 participants in the MIS BAIR randomized controlled trial.
- Utilized multivariable logistic regression to identify factors associated with antibiotic exposure.
Main Results:
- By age two, 67% of children had received at least one antibiotic course, with peak prescriptions between 9-18 months.
- Commonly prescribed antibiotics included amoxicillin (59%) and cefalexin (7%), often for respiratory infections and otitis media.
- Factors associated with exposure included Caesarean section, winter birth, maternal antibiotic use, formula feeding, and day-care attendance. 27% of treatments were for conditions unlikely to require antibiotics.
Conclusions:
- A significant majority of children are exposed to antibiotics in early life.
- A substantial proportion of antibiotic prescriptions in infants may be inappropriate, highlighting a need for improved stewardship.
Background:
Antibiotic exposure increases antimicrobial resistance and has also been associated with long-term harms, including allergies, inflammatory diseases and weight gain. We assessed antibiotic exposure in the first 2 years of life in Australian children, the factors influencing this and its appropriateness.
Methods:
Data from 1201 participants in the MIS BAIR randomized controlled trial were used. Multivariable logistic regression was used to identify factors associated with antibiotic exposure.
Results:
At 1 and 2 years of age, exposure to at least one course of antibiotics was 43% and 67%, with the highest first antibiotic prescription rate between 9 and 18 months. Amoxicillin was the most frequently used antibiotic (59%), followed by cefalexin (7%). The most common diagnoses for which antibiotics were prescribed were respiratory tract infections from 0 to 6 months of age and otitis media from 6 to 12 months. Factors associated with antibiotic exposure from 0 to 12 months of age were delivery by Caesarean section (adjusted odd-ratio (aOR) 1.5, 95%CI 1.1-1.9), birth in winter (aOR 1.7, 95%CI 1.2-2.4), maternal antibiotic exposure during the last trimester of pregnancy (aOR 1.6, 95%CI 1.1-2.3), cessation of breastfeeding by 6 months of age (aOR 1.5, 95%CI 1.1-2.0) and day-care attendance (aOR 1.4, 95%CI 1.1-1.8). Based on parent-reported questionnaires, 27% of infants were treated in the first year of life for conditions unlikely to need antibiotic treatment.
Conclusion:
At least two-thirds of children were prescribed antibiotics in the first 2 years of life, and more than a quarter of these exposures may have been unnecessary.
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