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. 2022 Oct 29;75(9):1537-1547.
doi: 10.1093/cid/ciac225.

Cumulative Antibiotic Exposure in the First 5 Years of Life: Estimates for 45 Low- and Middle-Income Countries From Demographic and Health Survey Data

Gillian A Levine  1   2 , Julia Bielicki  3   4 , Günther Fink  1   2
Affiliations

Cumulative Antibiotic Exposure in the First 5 Years of Life: Estimates for 45 Low- and Middle-Income Countries From Demographic and Health Survey Data

Gillian A Levine et al. Clin Infect Dis. .

Abstract

Background: Estimates of the total cumulative exposure to antibiotics of children in low-resource settings, and the source of these treatments, are limited.

Methods: We estimated the average number of antibiotic treatments children received in the first 5 years of life in 45 low- and middle-income countries (LMICs) using Demographic and Health Survey data. The 2-week point prevalence of fever, diarrhea, or cough and antibiotic treatment for these illnesses were estimated for ages 0-59 months and aggregated to estimate cumulative illness and antibiotic treatment for each country. We estimated treatment rates and contribution to total antibiotic use attributable to medical care, informal care, and self-medication.

Results: Forty-five countries contributed 438 140 child-observations. The proportion of illness episodes treated with antibiotics ranged from 10% (95% confidence interval [CI], 9%-12%]) in Niger to 72% (95% CI, 69%-75%) in Jordan. A mean of 42.7% (95% CI, 42.1%-43.3%) of febrile and 32.9% of nonfebrile (95% CI, 32.4%-33.5%) illness episodes received antibiotics. In their first 5 years, we estimate children received 18.5 antibiotic treatments on average (interquartile range [IQR], 11.6-24.6) in LMICs. Cumulative antibiotic exposure ranged from 3.7 treatments in Niger (95% CI, 2.8%-4.6%) to 38.6 treatments in the Democratic Republic of Congo (95% CI, 34.7%-42.4%). A median of 9.0% of antibiotic treatments was attributable to informal care (IQR, 5.9%-21.2%), and 16.9% to self-medication (IQR, 9.5%-26.2%).

Conclusions: Childhood antibiotic exposure is high in some LMICs, with considerable variability. While access to antibiotics for children is still not universal, important opportunities for reducing excess use also exist, particularly with respect to the informal care sector and self-medication.

Keywords: antibiotics; care-seeking; low- and middle-income countries; national estimates; pediatrics.

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Conflict of interest statement

Potential conflicts of interest. J. B. reports contracts or grants with the European and Developing Countries Clinical Trials Partnership (institution, Impact of duration of antibiotic therapy and of oral step-down to amoxicillin or co-amoxiclav on effectiveness, safety and selection of antimicrobial resistance in severe and very severe childhood community-acquired pneumonia (CAP): a randomised controlled trial (PediCAP Trial), project number, RIA2017MC-2023), Horizon 2020 (institution, Establishing Innovative Optimal Approaches for Infection Prevention of Resistant Bacteria in NICUs by Integrating Research, Implementation Science and Surveillance in a Sustainable Global Platform (Neo-IPC), grant number 965328), Swiss National Science Foundation (institution, A randomised controlled trial of adjunct corticosteroid therapy in hospitalised children with community acquired pneumonia (KIDS-STEP), grant number 173532), National Institute for Health Research (institution, project number 13/88/11), and Wellcome Trust (institution, Antimicrobial Resistance, Prescribing, and Consumption Data to Inform Country Antibiotic Guidance and Local Action [ADILA], award number 13573-10); consulting fees paid to institution from Pfizer and Sandoz; participation on data and safety monitoring boards or advisory boards (Phase Ib, Placebo-controlled Randomized Clinical Trial to Evaluate the Safety, Tolerability and Immunogenicity of INO-4201 Followed by Electroporation as a Booster Vaccination in Healthy Volunteers Who Have Previously Received the VSV-ZEBOV Vaccine (Boost-EBOV) Chair, unfunded; Avenir trial, member, expenses; Lakana trial, member, unfunded) and Trial Steering Committee (Finding the right dose of posaconazole for children & young people with Cystic Fibrosis and Aspergillus infection [cASPerCF] Chair, unfunded); and unpaid board membership for SwissPedNet. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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