Childhood antibiotic exposure for acute respiratory tract infections (RTIs) may be a good predictor for subsequent response failure (but not necessarily because of antibiotic treatment failure), suggests a new study in the British Journal of General Practice.
The observational cohort study used UK primary care data from the Clinical Practice Research Datalink, 2009 to 2016, to examine the relationship between the number of antibiotic courses prescribed to preschool children (12-60 months) for RTIs (upper and lower RTI or otitis media) in the preceding year, and subsequent RTIs that failed to respond to antibiotic treatment.
One random index antibiotic course for RTI per child during the study period was selected. Logistic regression models were used to estimate the odds between antibiotic exposure and response failure (up to 14 days after index antibiotic prescription).
The researchers found 252,572 preschool children who had a total of 1,546,364 acute RTI consultations during the study period, of which 45.27% (114,329) were prescribed an antibiotic course. Children had an average of six consultations for RTIs over the study period.
A total of 18,946 (16.57%) children received at least one antibiotic prescription for acute RTIs in the preceding year to the index prescription.
In the primary analysis, the authors observed 1377 response failures (1.20% of 114,329), of which 724 (52.58%) were referrals to an infection-related specialist service in secondary care, 306 (22.22%) were subsequent antibiotic prescriptions, 243 (17.65%) were emergency department visits within three days, 103 (7.48%) were hospital admissions, and one death.
Children who received two or more antibiotic courses for acute RTIs in the preceding year had greater odds of response failure after adjusting for covariates: adjusted odds ratio (OR) 1.32 (95% CI 1.04-1.66; P=0.02, n=97).
Further research is needed to improve understanding of the mechanisms underlying response failure, the authors concluded.