Children with asthma
are being prescribed unnecessary antibiotics
11 September, 2017
Milan, Italy:
Children
with asthma are more likely to be prescribed antibiotics even though there is
no evidence that they need them any more than children without asthma,
according to research to be presented at the European Respiratory Society
International Congress.
Overuse
of antibiotics is leading to a rise in drug-resistant infections and
unnecessary use in children could leave them more at risk of a future infection
that is difficult to treat.
The
researchers say their results may indicate that asthma symptoms are being
mistaken for a respiratory tract infection, or that the antibiotics are being
given as a preventative measure, even though guidelines do not support this.
The
study will be presented by Dr Esmé Baan from the department of medical informatics,
Erasmus University, Rotterdam, The Netherlands. She explains: “Asthma is a
common and ongoing condition, and it has symptoms that could be mistaken for a
respiratory tract infection. However, international and national guidelines
clearly state that antibiotics should not be given for a deterioration in
asthma symptoms, because this is rarely associated with a bacterial infection.
“Inappropriate
use of antibiotics can be bad for individual patients and the entire
population, and makes it harder to control the spread of untreatable
infections.”
The
study included 1.5 million children from the UK, including around 150,000 with
asthma, and a further 375,000 from The Netherlands, including around 30,000
with asthma. The researchers compared antibiotic prescription data for children
with and without asthma and compared the situation in The Netherlands with that
in the UK.
Both The
Netherlands and the UK follow the same international guidelines on asthma
treatment [1], which state that antibiotic use for asthma exacerbations is
generally not indicated.
The
researchers found that children with asthma were approximately 1.6 times more
likely to be prescribed antibiotics, compared to children who do not have
asthma. They also found that antibiotic prescription rates were almost two-fold
higher in the UK overall. In both countries, amoxicillin was the most commonly
used antibiotic.
In The
Netherlands, there were 197 antibiotic prescriptions per 1,000 children with
asthma per year, compared to 126 prescriptions per 1,000 children without
asthma. In the UK there were 374 prescriptions per 1,000 children with asthma
per year, compared to 250 per 1,000 children without asthma.
The
researchers say that since the pattern of overprescribing antibiotics to
children with asthma was the same in both countries, the situation is likely to
be the same elsewhere. The Netherlands has some of the lowest antibiotic use in
the world, so the situation in other countries where antibiotic use is much
higher, such as in Italy, Spain, Portugal and Greece, could potentially be far
worse.
Dr Baan
will tell the Congress: “Antibiotics should only be given when there is clear
evidence of a bacterial infection such as for pneumonia. However, we saw that,
in children with asthma, most of the antibiotic prescriptions in children were
intended for asthma exacerbations or bronchitis, which are often caused by a
virus rather than bacteria.
“It can
be difficult for a GP to differentiate between a deterioration in asthma
symptoms and a bacterial respiratory infection. We think this might be leading
to more antibiotic prescriptions in children with asthma.
“Children
with uncontrolled asthma can face difficulties over several years, for example
it can affect their ability to play and take part in sport, they may have more
days off school, or experience disturbed sleep. We don’t want to compound this
with prescribing drugs that won’t help and may be harmful.
“Of
course, sometimes antibiotics are needed, but we should be careful and only
prescribe them when they are really required. In general, we should discourage
GPs from prescribing unnecessary antibiotics or run the risk of more
drug-resistant infections in the future.”
