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Children with asthma being prescribed ‘unnecessary’ antibiotics

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Children with asthma are more likely to be prescribed antibiotics, even though there is no evidence that they need them any more than children without condition, according to researchers.

Those with asthma are nearly twice as likely to be given antibiotics compared to other children, according to a study presented today at the European Respiratory Society International Congress.

“Inappropriate use of antibiotics can be bad for individual patients and the entire population”

Esmé Baan

The researchers said their results suggested asthma symptoms were being mistaken for a respiratory tract infection, or that the antibiotics were being given as a preventative measure, even though guidelines did not support this practice.

The study included 1.5 million children from the UK, including around 150,000 with asthma, and a further 375,000 from the Netherlands, including around 30,000 with asthma.

The researchers compared antibiotic prescription data for children with and without asthma and compared the situation in the Netherlands with that in the UK.

Both countries follow the same international guidance on asthma treatment – Global Initiative for Asthma (GINA) guidelines – which state that antibiotic use for asthma exacerbations is generally not indicated, notes the study authors.

“Antibiotics should not be given for a deterioration in asthma symptoms”

Esmé Baan

They found that children with asthma were around 1.6 times more likely to be prescribed antibiotics, compared to children who do not have asthma.

They also found that antibiotic prescription rates were almost two-fold higher in the UK overall. In both countries, amoxicillin was the most commonly used antibiotic.

In the Netherlands, there were 197 antibiotic prescriptions per 1,000 children with asthma per year, compared to 126 prescriptions per 1,000 children without asthma.

In the UK, there were 374 prescriptions per 1,000 children with asthma per year, compared to 250 per 1,000 children without asthma.

The researchers highlighted that, since the pattern of overprescribing antibiotics to children with asthma was the same in both countries, the situation was likely to be the same elsewhere.

Holland has some of the lowest antibiotic use in the world, so the situation could potentially be far worse where antibiotic use is much higher, such as in Italy, Spain, Portugal and Greece, they warned.

“This study seems to indicate that asthma is being treated inappropriately in children”

Samantha Walker

The study will be presented at the annual conference in Milan, Italy, by study author Dr Esmé Baan from Erasmus University in Rotterdam.

She 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,” said Dr Baan.

She said: “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.

“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,” she noted.

Dr Baan accepted it was difficult for primary care clinicians to differentiate between a deterioration in asthma symptoms and a bacterial respiratory infection, which might be leading to more scripts.

She added: “Children with uncontrolled asthma can face difficulties over several years, for example, it can affect their ability to play and take part in sport, they may have more days off school, or experience disturbed sleep.

“We don’t want to compound this with prescribing drugs that won’t help and may be harmful,” she said.

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

Asthma UK

Children with asthma prescribed ‘unnecessary’ antibiotics

Samantha Walker

Dr Samantha Walker, director of research and policy at Asthma UK, said the study highlighted a need for urgent action to be taken to improve prescriber’s understanding of asthma and its treatment.

“Current guidelines for healthcare professionals on how to treat asthma do not recommend automatically prescribing antibiotics after an asthma attack,” said Dr Walker.

“But studies show that more than half of people who have asthma attacks are prescribed antibiotics anyway – either because it’s hard to tell the difference between a bacterial infection and asthma-related inflammation, or because patients have asked for antibiotics,” she said.

“It is important that international guidelines on asthma treatment are followed to make sure people are put on the treatment most likely to benefit them and to prevent a rise in the number of drug resistant infections,” she added.

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