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Repeated antibiotic exposure in children likely to result in future response failure

According to new research, children who have had two or more courses of antibiotics are more likely to have subsequent infections that then do not respond to the medication.

The findings, published in the British Journal of General Practice, showed that children under the age of five who received two or more antibiotic courses in the previous year for acute respiratory tract infections (RTI) had a greater likelihood of response failure for subsequent acute RTIs than children who received none.

The observational study looked at children aged one to five who were prescribed antibiotics for an upper and lower RTI or otitis media between 2009 and 2016.

Out of 114,329 children who were prescribed a course of antibiotics, those who received two or more courses in the preceding year were almost twice as likely to fail to respond to treatment than those who were not.

Children with a lower respiratory tract infection who had received two or more courses of antibiotics in the previous year, were 60% more likely to fail to respond to treatment than those who hadn't.

It was acknowledged that the response failures were not guaranteed to be a direct result of the antibiotic treatment failure, and further research is required to improve understanding of the mechanisms' underlying response failures. 

The research, based on records from a UK primary care database, said the 'clinically relevant implications' of childhood antibiotic exposure include antibiotic resistance, disruption to protective gut and lung microbiomes and clinical workload manifesting as treatment ‘failure’. 

The authors of the paper said: 'Incorporating these exposure data into clinical decision-support systems will prompt primary care clinicians to implement strategies to support nonantibiotic strategies, such as informing parents about the anticipated recovery period of common RTIs in children.

'This is especially true where the child does not have clinical evidence of an infection that obviously requires treatment with antibiotics. Indirectly, this can help curb expectations for antibiotics, and facilitate better shared decision making during consultations based on tangible outcomes that parents, or carers, and clinicians can relate to.'

This study follows Belgian research, which found last year that GP point-of-care testing 'effectively reduces antibiotic prescribing in children'.

Antimicrobial resistance (AMR) remains a growing concern across healthcare. Last autumn, the Government committed £32 million to accelerate the UK’s work on the topic, with Professor Dame Sally Davies, who previously deemed it as big a threat as terrorism, recently announced as the UK’s first special envoy on AMR. 

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