Children With Asthma Prescribed 'Unnecessary' Antibiotics

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Children with asthma are more likely to be prescribed antibiotics compared with other children, due to possible misdiagnosis, a study has found. Another study has found a link between respiratory tract infections in young children, and asthma and lung problems in later life.


Why are antibiotics being overprescribed?

Although there is no evidence that children with asthma need antibiotics more than other children, a clear pattern of this prescribing practice has emerged, according to research presented at the European Respiratory Society International Congress in Milan.

According to the researchers, this may indicate that asthma symptoms are being mistaken for a respiratory tract infection, or that the antibiotics are being given as a preventive measure.

Dr Esmé Baan from Erasmus University, The Netherlands, said: “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.”

As well as the overuse of antibiotics leaving individuals at higher risk of difficult-to-treat future infections, it also contributes to a rise in drug-resistant infections at population level.


The data

Nearly two million children took part in the study, including 1.5 million children from the UK, of which 150,000 had asthma, and 375,000 from The Netherlands, of which around 30,000 had asthma. Researchers compared the prescribing practices in The Netherlands and the UK, and also examined the prescription data for children with and without asthma.

Both countries follow the same international guidelines on asthma treatment, which state that antibiotic use for asthma exacerbations is generally not recommended.

In The Netherlands, there were 56% more antibiotic prescriptions for children with asthma, compared with children without asthma. In the UK, there were 50% more antibiotic prescriptions for children with asthma.


Global problem?

The researchers theorise that, as the pattern of overprescribing antibiotics to children with asthma was the same in both countries, there are likely to be similar trends in other countries. Additionally, they note that The Netherlands has some of the lowest antibiotic use in the world, so in other countries where antibiotic use is much higher, for example Italy, Spain, Portugal and Greece, there could be more pronounced over-prescribing.


Changes in prescribing

Dr Baan said: “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.

“Of course, sometimes antibiotics are needed, but we should be careful and only prescribe them when they are really required.”


Respiratory tract infections

At the same conference, research was presented showing that respiratory tract infections in young children are linked to an increased risk of asthma and worse lung function in later life.

The study of over 150,000 European children found that those who had had upper respiratory infections, such as colds, sinusitis, laryngitis and tonsillitis, by the age of five years had a 1.5-fold increased risk of developing asthma in later life.

And children who had suffered from lower respiratory tract infections, such as bronchitis, pneumonia and general chest infections, had a two- to four-fold increased risk of developing asthma in later life and were also more likely to have worse lung function.

Dr Evelien van Meel from the Erasmus MC University Medical Centre in The Netherlands, said: “These findings support the hypothesis that early-life respiratory tract infections may influence the development of respiratory illnesses in the longer term. In particular, lower respiratory tract infections in early life seem to have the greatest adverse effect on lung function and the risk of asthma.”

The researchers say that although there is a clear link, it is not yet known if the respiratory tract infections cause the asthma and worse lung function, or if wheezing and reduced lung function may be predisposing children to develop infections.

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