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. 2018 Nov 28;8(11):e022979.
doi: 10.1136/bmjopen-2018-022979.

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

Esmé J Baan  1 , Hettie M Janssens  2 , Tine Kerckaert  3 , Patrick J E Bindels  4 , Johan C de Jongste  2 , Miriam C J M Sturkenboom  5 , Katia M C Verhamme  1   3   6
Affiliations

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

Esmé J Baan et al. BMJ Open. .

Abstract

Objectives: To compare the rate, indications and type of antibiotic prescriptions in children with and without asthma.

Design: A retrospective cohort study.

Setting: Two population-based primary care databases: Integrated Primary Care Information database (IPCI; the Netherlands) and The Health Improvement Network (THIN; the UK).

Participants: Children aged 5-18 years were included from January 2000 to December 2014. A child was categorised as having asthma if there were ≥2 prescriptions of respiratory drugs in the year following a code for asthma. Children were labelled as non-asthmatic if no asthma code was recorded in the patient file.

Main outcome measures: Rate of antibiotic prescriptions, related indications and type of antibiotic drugs.

Results: The cohorts in IPCI and THIN consisted of 946 143 and 7 241 271 person years (PY), respectively. In both cohorts, antibiotic use was significantly higher in asthmatic children (IPCI: 197vs126 users/1000 PY, THIN: 374vs250 users/1000 PY). In children with asthma, part of antibiotic prescriptions were for an asthma exacerbation only (IPCI: 14%, THIN: 4%) and prescriptions were more often due to lower respiratory tract infections then in non-asthmatic children (IPCI: 18%vs13%, THIN: 21%vs12%). Drug type and quality indicators depended more on age, gender and database than on asthma status.

Conclusions: Use of antibiotics was higher in asthmatic children compared with non-asthmatic children. This was mostly due to diseases for which antibiotics are normally not indicated according to guidelines. Further awareness among physicians and patients is needed to minimise antibiotic overuse and limit antibiotic resistance.

Keywords: asthma; epidemiology; infectious diseases; paediatrics; primary care.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Age and asthma status-specific annual prevalence rate of antibiotic use. IPCI, Integrated Primary Care Information database; THIN, The Health Improvement Network; PY, person years.
Figure 2
Figure 2
Annual prevalence rate of antibiotic use by calendar year. IPCI, Integrated Primary Care Information database; THIN, The Health Improvement Network; PY, person years.
Figure 3
Figure 3
Indications of antibiotic use: proportion of known indications. IPCI, Integrated Primary Care Information database; LRTI, lower respiratory tract infection; SKIN, skin infection; THIN, The Health Improvement Network; URTI, upper respiratory tract infection; UTI, urinary tract infection.
Figure 4
Figure 4
Indications of lower respiratory tract infections. IPCI, Integrated Primary Care Information database; THIN, The Health Improvement Network.
Figure 5
Figure 5
Age, gender and asthma-specific antibiotic prescriptions in the Integrated Primary Care Information database.
Figure 6
Figure 6
Age, gender and asthma-specific antibiotic prescriptions in The Health Improvement Network.
See this image and copyright information in PMC

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