Antibiotic use in children with asthma: cohort study in UK and Dutch primary care databases

Baan, Esmé J.; Janssens, Hettie M.; Kerckaert, Tine; Bindels, Patrick J E; Jongste, Johan C. de; Sturkenboom, Miriam; Verhamme, Katia

doi:10.1136/bmjopen-2018-022979

Cited by 25 publications

(30 citation statements)

References 27 publications

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“…Overuse of antibiotics is an urgent issue in worldwide and in China [ 1 , 2 , 3 ]. Several studies have investigated associations of antibiotics exposures during the early lifetimes with childhood asthma and allergies [ 1 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. However, conclusions among these studies were inconsistent.…”

Section: Introductionmentioning

confidence: 99%

First-Year Antibiotics Exposure in Relation to Childhood Asthma, Allergies, and Airway Illnesses

Zou

Liu

Huang

et al. 2020

IJERPH

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Background: Associations of early antibiotics exposures with childhood asthma, allergies, and airway illnesses are debated. Objectives: We aimed to investigate associations of first-year antibiotics exposure with childhood asthma, allergies, and airway illnesses. Methods: A cross-sectional study was conducted among preschoolers in Shanghai, China during 2011–2012. A questionnaire regarding household environment and lifestyles and childhood health outcomes was reported by the child’s parents. Results: In total, 13,335 questionnaires (response rate: 85.3%) were analyzed and 3049 (24.1%) children had first-year antibiotics exposure. In the multivariate logistic regression analyses, first-year antibiotics exposure had significant associations with the higher odds of lifetime-ever pneumonia (adjusted OR, 95% CI: 2.15, 1.95–2.37), croup (1.46, 1.24–1.73), wheeze (1.44, 1.30–1.60), asthma (1.38, 1.19–1.61), food allergy (1.29, 1.13–1.46), and allergic rhinitis (1.23, 1.07–1.41), and as well as current (one year before the survey) common cold (≥3 times) (1.38, 1.25–1.52), dry cough (1.27, 1.13–1.42), atopic dermatitis (1.25, 1.09–1.43), wheeze (1.23, 1.10–1.38), and rhinitis symptoms (1.15, 1.04–1.26). These associations were different in children with different individual characteristics (age, sex, family history of atopy, and district) and other early exposures (breastfeeding, home decoration, pet-keeping, and environmental tobacco smoke). Conclusions: Our results indicate that first-year antibiotics exposure could be a strong risk factor for childhood pneumonia, asthma, allergies, and their related symptoms. The individual characteristics and other early exposures may modify effects of early antibiotic exposure on childhood allergies and airway illnesses.

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Section: Introductionmentioning

confidence: 99%

First-Year Antibiotics Exposure in Relation to Childhood Asthma, Allergies, and Airway Illnesses

Zou

Liu

Huang

et al. 2020

IJERPH

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“…Previous domain-specific research in primary care has focused on priority or highrisk drug classes, particularly antibiotics, where variation in the overall number of agents, broad-spectrum agents and non-first-line agents in the DU90% has been examined. [30][31][32][33][34] Variation in DU90% profiles of non-steroidal anti-inflammatory drugs [35][36][37] and CNS agents has also been examined. 38 39 Audit and feedback is an important intervention for quality improvement.…”

Section: Discussionmentioning

confidence: 99%

How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England

Chiedozie¹,

Murphy²,

Fahey³

et al. 2021

BMJ Open

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AimTo apply the drug utilisation 90% (DU90%) indicator (the number of unique drugs which makes up 90% of a doctor’s prescribing) to general practitioner (GP) practices prescribing in England to examine time trends, practice-level variation, and relationships with practice characteristics, prescribing costs and low-value prescribing.Study designRetrospective cohort study.SettingPrimary care in England, using publicly available prescribing data available from the National Health Service (NHS) digital platform for 2013–2017.ParticipantsAll general practices in England (n=7620).Primary and secondary outcome measuresThe DU90% was calculated on an annual basis for each practice based on medication British National Formulary codes. Low-value prescribing was defined using NHS 2017 guidance (including lidocaine plasters, liothyronine, omega-3 supplements). Descriptive statistics were generated per year on time trends and practice-level variation in the DU90%. Multilevel linear regression was used to examine the practice characteristics (relating to staff, patients and deprivation of the practice area).ResultsAmong 7620 practices, mean DU90% ranged from 130.0 to 131.0 across study years, and regarding variation between practices, there was a 1.4-fold difference between the lowest and highest 5% of practices. A range of medications were included in the DU90% of virtually all practices, including atorvastatin, levothyroxine, omeprazole, ramipril, amlodipine, simvastatin and aspirin. A higher volume of prescribing was associated with a lower DU90%, while having more patients, higher proportions of patients who are women or aged ≥45 years, higher number of GPs working in the practice and being in a more deprived area were associated with a higher DU90%. Practices in higher quintiles of DU90% had higher levels of low-priority prescribing and prescribing costs.ConclusionGP practices typically use 130 different medications in the bulk of their prescribing. Higher DU90% was associated with higher levels of low-priority prescribing and prescribing costs. Increasing use of personal formularies may enhance prescribing quality and reduce costs.

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“…A possible explanation is that the discord might be the result of excessive watch group antibiotic use for exacerbation of chronic respiratory diseases. On the one hand, routine use of antibiotics for asthma exacerbation is not supported by sufficient evidence [24] but is common in clinical practice according to studies in the US and Europe [25][26][27]. On the other hand, although long-term macrolide use can effectively reduce the exacerbation of COPD Fig.…”

Section: Discussionmentioning

confidence: 99%

Microbiology testing associated with antibiotic dispensing in older community-dwelling adults

et al. 2020

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Background: It is commonly recommended that microbiological assessment should accompany the use of antibiotics prone to resistance. We sought to estimate the rate of microbiology testing and compare this to dispensing of the World Health Organization classified "watch" group antibiotics in primary care. Methods: Data from a cohort of older adults (mean age 69 years) were linked to Australian national health insurance (Pharmaceutical Benefits Scheme & Medicare Benefits Schedule) records of community-based antibiotic dispensing and microbiology testing in 2015. Participant characteristics associated with greater watch group antibiotic dispensing and microbiology testing were estimated using adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) in multivariable zero-inflated negative binomial regression models. Results: In 2015, among 244,299 participants, there were 63,306 watch group antibiotic prescriptions dispensed and 149,182 microbiology tests conducted; the incidence rate was 0.26 per person-year for watch group antibiotic dispensing and 0.62 for microbiology testing. Of those antibiotic prescriptions, only 19% were accompanied by microbiology testing within − 14 to + 7 days. After adjusting for socio-demographic factors and co-morbidities, individuals with chronic respiratory diseases were more likely to receive watch group antibiotics than those without, e.g. asthma (aIRR:1.59, 95%CI:1.52-1.66) and chronic obstructive pulmonary disease (COPD) (aIRR:2.71, 95%CI:2.48-2.95). However, the rate of microbiology testing was not comparably higher among them (with asthma aIRR:1.03, 95%CI:1.00-1.05; with COPD aIRR:1.00, 95%CI:0.94-1.06). Conclusions: Priority antibiotics with high resistance risk are commonly dispensed among community-dwelling older adults. The discord between the rate of microbiology testing and antibiotic dispensing in adults with chronic respiratory diseases suggests the potential for excessive empirical prescribing.

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Antibiotic use in children with asthma: cohort study in UK and Dutch primary care databases

Cited by 25 publications

References 27 publications

First-Year Antibiotics Exposure in Relation to Childhood Asthma, Allergies, and Airway Illnesses

First-Year Antibiotics Exposure in Relation to Childhood Asthma, Allergies, and Airway Illnesses

How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England

Microbiology testing associated with antibiotic dispensing in older community-dwelling adults

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