Antibiotic Prescription Is Often Unnecessary Among Children in Lower-Income Countries

Antibiotics are often overprescribed to children younger than age 5 years in low- and middle-income countries (LMICs), according to a new study. 

“Between birth and age 5 years, children in LMICs are prescribed a remarkably high number of antibiotics,” the researchers wrote.

To reach this conclusion, the researchers studied data on children younger than age 5 years who had visited a health care facility in Haiti, Kenya, Malawi, Namibia, Nepal, Senegal, Tanzania, or Uganda between May 2006 and December 2016.

The cumulative number of illnesses related to a fever or cough and the cumulative number of visits to a health care facility because of these illnesses for each country were obtained through Demographic and Health surveys. From these surveys, the researchers identified 68,826 children younger than age 5 years who had visited a health care facility between May 2006 and November 2016.

The researchers also assessed clinical observation data from nationally representative health care facility-based Service Provision Assessment surveys. Overall, the researchers identified 22,519 clinical observations of children younger than age 5 years who had visited a health care facility because of an illness between July 2007 and December 2016.

Using all this data, the cumulative antibiotic exposure among children from birth to age 5 years in each LMIC was estimated. 

Of all of the identified health care facility visits, 85.4% were related to fever or cough.

Antibiotics were prescribed to 80.5% of children diagnosed with respiratory illness, 50.1% with diarrhea, and 28.3% with malaria. 

Between birth and age 5 years, children across the 8 LMICs were prescribed a mean 24.5 antibiotic prescriptions. Senegal had the lowest mean number (7.1), and Uganda had the highest mean number (59.1).

“National and local efforts to reduce unnecessary prescription of antibiotics to children would likely improve both patient wellbeing (in terms of preventing [adverse] effects) and reduce the global threat of antimicrobial resistance,” the researchers concluded.

—Colleen Murphy

Reference:

Fink G, D'Acremont V, Leslie HH, Cohen J. Antibiotic exposure among children younger than 5 years in low-income and middle-income countries: a cross-sectional study of nationally representative facility-based and household-based surveys. Lancet Infect Dis. 2020;20(2):179-187. https://doi.org/10.1016/S1473-3099(19)30572-9.