Antibiotic treatment for non-specific upper respiratory tract infections and exacerbation risk in children with
Carmen Cañete Ramirez1,2, Albina Tskhay2,3, Ana C Blanchard2
1Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada.
Insights
Antibiotics for childhood respiratory infections may increase asthma exacerbation risk. Broad-spectrum antibiotics showed a modest increase in asthma flare-ups within six months, though absolute risk differences were small.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacy
- Epidemiology
Background:
- Antibiotic overuse in children with asthma for non-specific upper respiratory tract infections (NS-URTIs) is common.
- The impact of antibiotic use on asthma exacerbation risk in pediatric populations remains unclear.
Purpose of the Study:
- To investigate the association between antibiotic use and asthma exacerbation risk in children with pre-existing asthma following NS-URTIs.
- To compare the risk of exacerbation associated with no antibiotics, narrow-spectrum antibiotics, and broad-spectrum antibiotics.
Main Methods:
- Emulation of target trials using Quebec administrative health and drug claims data for children aged 0-17 years with asthma.
- Analysis of antibiotic initiation (none, narrow-, or broad-spectrum) within three days of an NS-URTI visit.
- Primary outcome: asthma exacerbation (oral corticosteroid use, ED visits, or hospitalizations) within six months, assessed using inverse probability of treatment weighted log-binomial models.
Main Results:
- Out of 13,646 children (24,139 person-trials), 8.8% received narrow-spectrum and 11.4% received broad-spectrum antibiotics.
- Compared to no antibiotics, narrow-spectrum antibiotics were associated with a risk ratio of 1.26 (95% CI, 0.99-1.53) and broad-spectrum antibiotics with 1.28 (95% CI, 1.03-1.54).
- Broad-spectrum antibiotics showed a modestly higher risk of exacerbation, with small absolute risk differences (<0.1%).
Conclusions:
- Antibiotic use, particularly broad-spectrum, following NS-URTIs in children with asthma may be associated with a slight increase in exacerbation risk.
- While statistically significant, the absolute increase in asthma exacerbation risk was minimal.
- Further research may inform judicious antibiotic prescribing practices in pediatric asthma management.
Abstract:
Antibiotics are often prescribed to children with asthma for non-specific upper respiratory tract infections (NS-URTIs), but their association with exacerbation risk in children with pre-existing asthma is unclear. We aimed to determine if antibiotics are associated with asthma exacerbation risk in the 6 months following NS-URTI resolution. Using Quebec administrative health and drug claims data, we emulated a series of target trials among children (0-17 years) with asthma visiting an outpatient physician for an NS-URTI. Treatment strategies were no, narrow-, or broad-spectrum antibiotics initiated within 3 days following the index visit. The primary outcome was exacerbation during the 6 months following an initial 10-day induction period, defined as oral corticosteroid use, emergency department visits, or hospitalizations for asthma. Risk ratios (RR) and differences (RDs) were estimated using inverse probability of treatment weighted log-binomial models. Among 13 646 children (24 139 person-trials), 8.8% and 11.4% received narrow- and broad-spectrum antibiotics, respectively. Compared with no antibiotics, narrow-spectrum antibiotics were associated with an RR of 1.26 (95%CI, 0.99-1.53; RD, 0.07%), while broad-spectrum antibiotics were associated with an RR of 1.28 (95%CI, 1.03-1.54; RD, 0.08%). Broad-spectrum antibiotics were associated with modestly higher exacerbation risks, although absolute RDs were small (<0.1%).
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