Use of antibiotics in children younger than two years in eight countries: a prospective cohort study

Abstract

ObjectiveTo describe the frequency and factors associated with antibiotic use in early childhood, and estimate the proportion of diarrhoea and respiratory illnesses episodes treated with antibiotics.MethodsBetween 2009 and 2014, we followed 2134 children from eight sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa and the United Republic of Tanzania, enrolled in the MAL-ED birth cohort study. We documented all antibiotic use from mothers’ reports at twice-weekly visits over the children’s first two years of life. We estimated the incidence of antibiotic use and the associations of antibiotic use with child and household characteristics. We described treatment patterns for diarrhoea and respiratory illnesses, and identified factors associated with treatment and antibiotic class.FindingsOver 1 346 388 total days of observation, 16 913 courses of antibiotics were recorded (an incidence of 4.9 courses per child per year), with the highest use in South Asia. Antibiotic treatment was given for 375/499 (75.2%) episodes of bloody diarrhoea and for 4274/9661 (44.2%) episodes of diarrhoea without bloody stools. Antibiotics were used in 2384/3943 (60.5%) episodes of fieldworker-confirmed acute lower respiratory tract illness as well as in 6608/16742 (39.5%) episodes of upper respiratory illness. Penicillins were used most frequently for respiratory illness, while antibiotic classes for diarrhoea treatment varied within and between sites.ConclusionRepeated antibiotic exposure was common early in life, and treatment of non-bloody diarrhoea and non-specific respiratory illnesses was not consistent with international recommendations. Rational antibiotic use programmes may have the most impact in South Asia, where antibiotic use was highest.

Infant Nutritional Status, Feeding Practices, Enteropathogen Exposure, Socioeconomic Status, and Illness Are Associated with Gut Barrier Function As Assessed by the Lactulose Mannitol Test in the MAL-ED Birth Cohort

“…Variables related to water and sanitation such as improved flooring, poultry ownership, and a hygiene score based on three questions related to handwashing practices 31 were also evaluated.…”

Iron-containing micronutrient powders modify the effect of oral antibiotics on the infant gut microbiome and increase post-antibiotic diarrhoea risk: a controlled study in Kenya

“…Antibiotics are one of the most commonly prescribed medications to infants, and they are prescribed early and often 2 3. In children younger than 2 years of age living in low-resource settings, an average of 4.9 antibiotic courses per child year are given 2. In rural Tanzania, more than 50% of infants receive antibiotics by the age of 6 months, and antibiotic use peaks between 6 months and 12 months of age 2.…”

“…In children younger than 2 years of age living in low-resource settings, an average of 4.9 antibiotic courses per child year are given 2. In rural Tanzania, more than 50% of infants receive antibiotics by the age of 6 months, and antibiotic use peaks between 6 months and 12 months of age 2. Antibiotics strongly modify the gut microbiome composition in adults4–8 and may increase colonisation by enteric pathogens 8–10.…”

The Burden of Enteropathy and “Subclinical” Infections

“…109 Intervention planning should also account for existing practices in the targeted community. For example, interventions involving targeted antimicrobial use may be severely limited by current widespread use even early in life 110 and concerns about antimicrobial resistance.…”