Antibiotics falter in infants with history

Is this another reason for more cautious antibiotics prescribing?

Young children with a history of being prescribed antibiotics have a higher chance of failing to respond to their next course of antibiotics, a UK study shows.

The observational study looked at around 114,000 UK children under the age of five who were prescribed antibiotics for respiratory tract infections between 2009 and 2016.

Out of this cohort, around 4,000 children (3%) had received two or more courses of antibiotics in the previous year.

These heavy-antibiotics users had a 32% greater risk of “failing to respond” to their next antibiotics treatment than their peers, the study found. 

Treatment was deemed to have failed if a child was admitted to hospital, needed another antibiotics prescription, was referred to an infection specialist or died with 14 days of being prescribed antibiotics.

Around 1% of antibiotics courses failed in the study overall, affecting around 1,400 patients.

While the observational study couldn’t prove that taking antibiotics repeatedly made the drugs less effective, there was some research suggesting this was the case, the authors said.

“There is robust evidence for an association between antibiotic use and resistant bacterial carriage,” the authors said.

“Antibiotic use may also disrupt the protective gut and lung microbiomes, and potentially predispose young children to increased susceptibility to certain bacterial and opportunistic pathogens.”

Every attempt was made to adjust for important confounding factors in the study (including comorbidities, vaccination status, previous antibiotics failure, and previous consultations for infections), but it was not possible to identify all of them, the authors said.

It could be that children who took lots of antibiotics in the past were less healthy and were therefore less likely to respond to future medication (rather than the antibiotics themselves causing the treatment failure), the authors said.

The theoretical predictions around antibiotic resistance and the push for less antibiotic prescribing could often seem “abstract and remote”, the authors said. This study brought the conversation back down to earth.   

“The present findings suggest that when children receive more antibiotics their likelihood of re-consulting a health professional is affected and increases clinical workload, even though the majority of respiratory tract infections in children are viral, self-limiting, and would not be expected to have benefited from antibiotic treatment.”

British Journal of General Practice, 29 August