Children with asthma often prescribed unnecessary antibiotics

Health care providers in at least two European countries are often prescribing unnecessary antibiotics for children with asthma, according to researchers.

Medical records for patients in the Netherlands and the United Kingdom show that children with asthma are prescribed antibiotics much more often than those who do not have the condition, the researchers said at the European Respiratory Society International Congress in Milan.

They suggested that physicians may issue the prescriptions after misdiagnosing asthma symptoms.

“Asthma is a common and ongoing condition, and it has symptoms that could be mistaken for a respiratory tract infection,” study researcher Esmé Baan, MD, of the department of medical informatics at Erasmus University in Rotterdam, the Netherlands, said in a news release. “However, 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 it makes it harder to control the spread of untreatable infections.”

Baan added that antibiotics are often used for the wrong indication.

“Antibiotics should only be given when there is clear evidence of a bacterial infection, such as pneumonia,” Baan said. “However, we saw that, in children with asthma, more of the antibiotic prescriptions in children were intended for asthma exacerbations or bronchitis, which are often caused by a virus rather than bacteria.”

Altogether, the researchers included records for 375,000 patients in the Netherlands and 1.5 million in the U.K. Of those patients, 30,000 in the Netherlands and 150,000 in the U.K. had asthma.

The researchers found that, in the Netherlands, children with asthma received 178 antibiotic prescriptions per 1,000 person-years, compared with 131 per 1,000 person-years for those without asthma. Similarly, in the U.K., those with asthma received 380 prescriptions per 1,000 person-years compared with 261 per 1,000 person-years for those without asthma.

Caregivers were also using antibiotics for lower respiratory tract infection symptoms more often in children with asthma than in those without asthma, the researchers said. In the Netherlands, 28% of all antibiotic prescriptions in children with asthma and 14% of antibiotic prescriptions in children without asthma were due to lower respiratory tract infections. The proportion was nearly the same in the U.K., at 25% and 12%, respectively.

Amoxicillin was the antibiotic most often prescribed in both countries, according to the news release.

The rate of antibiotic use in the Netherlands is among the world’s lowest, the release said. That leads the researchers to believe that countries including Italy, Spain, Portugal and Greece, which have much higher overall antibiotic use, could also have much higher rates of unnecessary antibiotic prescriptions for children with asthma. – by Joe Green

Disclosure: Baan reports no relevant financial disclosures.

Reference: Baan E, et al. Abstract OA3449. Presented at: European Respiratory Society International Congress. Sept. 9-13, 2017; Milan.