Date Published: 16 December 2019

Some children receive an average of 25 antibiotic prescriptions in their first five years

It has been found by a recent study1 that children in low- and middle-income countries (LMICs) receive an average of 25 antibiotic prescriptions in their first five years. This is considered an excessive quantity by the authors of the study due to concerns that so much could harm the children's ability to fight pathogens as well as increase antibiotic resistance worldwide.

" We knew children in LMICs are sick more often, and we knew antibiotic prescription rates are high in many countries. What we did not know was how these elements translate into actual antibiotic exposure - and the results are rather alarming," said Günther Fink, lead author of the study and head of the Household Economics and Health Systems Research unit at Swiss TPH2.

This recent study is thought to be the the first to consider total antibiotic prescribing in children under the age of five in low- and middle-income countries. Its findings are of concern in terms of the possible effects of increasing antimicrobial resistance on human health globally, and also in terms of the possible health consequences for the particular children whose medical treatment was studied.

Global health threat

Antimicrobial resistance is what happens when microorganisms (e.g. bacteria, viruses, fungi and parasites) adapt in ways that result in the medications used to cure the infections they cause becoming ineffective or at least less effective. This can happen naturally but is much exacerbated by the inappropriate use of medicines, for example using antibiotics for viral infections such as cold or flu, or sharing antibiotics. According to the World Health Organization3 low-quality medicines, wrong prescriptions and poor infection prevention and control also encourage the development and spread of drug resistance. One of the behaviours that contributes to the global health threat of antimicrobial resistance is the excessive use of antibiotics worldwide. Previous studies have shown that antibiotics are overprescribed to children in many countries. In Tanzania, for instance, several studies have shown that over 90% of children who visit a health facility receive an antibiotic, although only in about 20% of the cases treatment was actually required1,2.

The recent study analyzed data from 2007–2017 from health facilities and household surveys from eight countries: Haiti, Kenya, Malawi, Namibia, Nepal, Senegal, Tanzania, and Uganda. It found that, on average, children received 25 antibiotic prescriptions through age five. This is considered very high, especially since two antibiotic prescriptions per year is considered excessive in many high-income settings. Data indicated that antibiotics were administered in 81% of cases for children with a respiratory illness, in 50% for children with diarrhea (see also causes of diarrhea), and in 28% for children with malaria.

The researchers also found that the number of antibiotic prescriptions in early childhood varied from country to country. While a child in Senegal received approximately one antibiotic prescription per year in the first five years of life, a child in Uganda was prescribed up to 12. In comparison, a prior study showed that children under five in Europe receive less than one antibiotic prescription per year on average.

" This number is still high given that the vast majority of infections in this age group are of viral origin," said Valérie D'Acremont, a study co-author and head of the Management of Fevers group at the Swiss Tropical and Public Health Institute (TPH).

" What is unique about this study is that it provides a much more comprehensive picture of pediatric antibiotic exposure in LMICs than what has been reported previously. It combines both household data on where and when children are brought for care with data from direct observations of health care workers caring for sick children," said Jessica Cohen, Associate Professor of Global Health at Harvard Chan School and senior author of the study.

Impact on children

" The consequences of antibiotic overprescription not only pose a huge threat to global health, but can also result in a concrete health impact for these children," said Valérie D'Acremont2.
" Excess antibiotic use destroys the natural gut flora which is essential to fighting pathogens."

Research on this subject is continuing and includes a project underway at the Swiss TPH4 to improve understanding of the health impact of overusing antibiotics on children.

" Understanding the concrete impact on individual children is crucial to achieve a policy change," said Dr Günther Fink of the Swiss Tropical and Public Health Institute, Basel, Switzerland.

His research team is currently comparing health policies at country level to identify best practices that lead to lower antibiotic prescription rates.

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