When children have received two or more antibiotic prescriptions in a given year for common respiratory tract infections, further antibiotic treatments are around 30% less likely to be effective, according to a study by researchers at the universities of Oxford, Southampton and Cardiff.
The cohort study used the Clinical Practice Research Datalink to identify UK primary care data for children aged 1—5 years during the period 2009—2016. Children requiring long-term antibiotic treatment for chronic respiratory diseases such as TB were excluded.
Analysing data for the 114,329 children who were prescribed an antibiotic for acute respiratory tract infection during the study period, the researchers found that those who had been prescribed one course in the preceding year were 3% more likely to fail to respond to a subsequent course; those who had been given at least two previous courses were 32% more likely to fail to respond.
The overall rate of treatment failure was 1.2%, with a total of 1377 cases recorded. Of these the majority (52.6%) comprised referrals to an infection-related specialist service in secondary care, 22.2% were subsequent antibiotic prescriptions, 17.7% were emergency department visits within 3 days and 7.5% were hospital admissions. There was one death.
The researchers believe the increased rate of treatment failure associated with previous antibiotic prescriptions may not only be due to the emergence of resistant organisms or disruption of the microbiome, but could also be related to parental expectations of further treatment, together with a lack of awareness that many childhood coughs and colds can go on for up to 3 weeks.