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Asthmatic children more likely to be given antibiotics

Monday September 11th, 2017

Children with asthma are often likely to be prescribed antibiotics - even though there is no evidence to suggest the medication is effective, a European conference has heard.

Scientists at Erasmus University, Rotterdam, The Netherlands, say their findings point to doctors prescribing the medication as a preventative measure or because symptoms could be mistaken for a respiratory tract infection.

Dr Esmé Baan, from the university’s the department of medical informatics, told delegates at the European Respiratory Society International Congress 2017, in Milan, Italy, that guidelines do not support the use of antibiotics.

“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,” she said.

"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."

Dr Baan’s study included 1.5 million children from the UK, including approximately 150,000 with asthma, and 375,000 from The Netherlands, about 30,000 of whom have the condition.

The research team compared antibiotic prescription data for children with and without asthma and compared The Netherlands with the UK, both of which follow the same international guidelines on asthma treatment.

The researchers found that in The Netherlands, there were 197 antibiotic prescriptions per 1,000 children with asthma per year compared with 126 prescriptions per 1,000 children without asthma. In the UK there were 374 prescriptions per 1,000 children with asthma per year compared with 250 per 1,000 children without asthma.

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.”

• In another study to be presented to Congress Dr Evelien van Meel will reveal that young children who suffer from respiratory tract infections are more at risk of developing asthma and having a worse lung function in later life.

Dr van Meel, from the Generation R Study Group at Erasmus MC University Medical Centre, The Netherlands, will present findings from an international study of 154,942 European children in which they found that those who had had upper respiratory infections by the age of five years had a 1.5-fold increased risk of developing asthma in later life.

Children who had suffered from lower respiratory tract 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.

“These findings support the hypothesis that early-life respiratory tract infections may influence the development of respiratory illnesses in the longer term,” she said.

“In particular, lower respiratory tract infections in early life seem to have the greatest adverse effect on lung function and the risk of asthma. However, at this stage we cannot say for certain whether the relationship is causal.”

Abstract no: OA499, “Early-life respiratory tract infections and the risk of lower lung function and asthma: a meta-analysis of 154,492 children”; Determinants of childhood asthma and atopy session, 10.45-12.45 hrs CEST, Sunday 10 September, Brown 1+2 (south).

Abstract no: OA3449, "Antibiotic use in children with asthma", Small airways, long distances and large databases in paediatric asthma session, 10.45-12.45 hrs, Tuesday 12 September, Brown 3 (South)

Tags: Allergies & Asthma | Child Health | Europe | Pharmaceuticals | Respiratory

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