Under-5's receiving an average 25 antibiotic prescriptions each year

By Dr. Ananya Mandal, MDDec 15 2019

Antibiotic resistance is one of the greatest threats to mankind says the World Health Organization (WHO). One of the greatest contributors to this menace is indiscriminate use of antibiotics.

A new study from the Swiss Tropical and Public Health Institute and the Harvard T. N. Chan School of Public Health, has revealed that children from low and middle income countries (LMIC) were more likely to be prescribed antibiotics unnecessarily.

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The results of the new study is published on the 13th of December 2019 in the latest issue of The Lancet Infectious Diseases. The study is titled, “Antibiotic exposure among children under age five: A cross-sectional analysis of nationally representative facility and household surveys in 8 low- and middle-income countries.”

A team of researchers noted that children from LMIC were prescribed an average of 25 prescriptions containing antibiotics in the first five years of their lives. It is this rise in the antibiotic prescriptions that result in exacerbation of antibiotic resistance say experts. This many antibiotics consumed so early in their lives are also associated with incapacitating the immune systems of the children to fight off infections.

Each of the nations studied had different average antibiotic prescription rates found the study. On the lower side were countries like Senegal where the number was an average of 1 or less per year in the first five years of life and on the higher side was Uganda where up to 12 antibiotic prescriptions were seen per year in the first five years of life.

Valérie D'Acremont, head of the Management of Fevers group at Swiss TPH and one of the lead authors of this study explained that European children receive less than one antibiotic prescription per year in the first five years and she added, “This number is still high given that the vast majority of infections in this age group are of viral origin.” D'Acremont explained that the impact of these high rates of prescription antibiotics is great and global. She added, “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. Excess antibiotic use destroys the natural gut flora which is essential to fighting pathogens.”

Günther Fink, senior author of the study and head of the Household Economics and Health Systems Research unit at Swiss TPH, in a statement said, “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.”

The WHO has warned that repeated and unnecessary antibiotic usage needs to stop in order to curb antibiotic resistance. Many strains of the common bacteria now are capable of fighting off the known antibiotics and are becoming difficult to treat says the WHO. Studies have shown that in countries Tanzania, over 90 percent visits to be healthcare professionals by children results in an antibiotic prescription. Actual need for the prescriptions of antibiotics remain at around 20 percent say experts.

For this study the team looked at health record data from 2007 to 2017 collected from household surveys and healthcare set ups. Eight countries were studied in the process, says the new study. These were Haiti, Kenya, Malawi, Namibia, Nepal, Senegal, Tanzania, and Uganda. The results of 25 antibiotic prescriptions in the first five years of life translated to at least 5 antibiotic prescriptions per year. The team explained that for high income countries over two antibiotic prescriptions per year is considered to be “too much”. Commonest antibiotic prescriptions were for respiratory tract infections (in 81 percent children) and for diarrhoea (50 percent). Further 28 percent prescriptions came for infections such as malaria.

Jessica Cohen, Associate Professor of Global Health at Harvard Chan School and one of the authors of this study said, “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.”

Lead author Fink said, “Understanding the concrete impact on individual children is crucial to achieve a policy change.” He added that the whole team is working towards understanding the global impact of this indiscriminate antibiotic prescribing in children. The team is also looking at nation-specific policies that guide antibiotic use in prescriptions and would compare them with the actual antibiotic prescription rates.