ART reduces antibiotic prescriptions for HIV-exposed infants

Malawian infants who were exposed to HIV but were uninfected were less likely to receive antibiotic therapy when either the infant or their mother received antiretroviral prophylaxis while breastfeeding, according to research published in Emerging Infectious Diseases.

“Because infants are more susceptible than adults to infectious diseases, antibacterial drug administration to infants is correspondingly higher,” Alexander C. Ewing, MPH, associate service fellow at the CDC’s Division of Reproductive Health, and colleagues wrote. “In sub-Saharan Africa, a growing population at especially high risk for infectious diseases is HIV-exposed, uninfected infants, many of whom breastfeed.”

Ewing and colleagues studied the health care needs of 2,152 infants who were HIV-exposed and uninfected. The infants received antiretroviral (ARV) regimens from birth to age 28 weeks, or when they were weaned from breastfeeding. The regimens included daily nevirapine for infants or a triple-drug ARV regimen for the mothers.

Most infants (80.3%) included in the analysis received at least one prescription for an antibiotic at follow-up. Of the 5,107 total antibiotic prescriptions, more than half (67.3%) were for respiratory illnesses, with most of these prescriptions given for acute respiratory infections or upper respiratory tract infections (66.7%) and pneumonia (6.8%).

Approximately one-quarter of prescriptions were for “other” respiratory conditions. Other indications for which antibiotics were prescribed included gastrointestinal conditions (11.6%) and skin conditions (6.1%). When antibiotics were prescribed, infants were most commonly given penicillin (41.8%), sulfonamides (23.4%) and tetracyclines or macrolides (16.9%).

In a Cox proportional hazards model, the researchers identified several factors that were associated with a lower likelihood that infants would receive antibiotics. The largest reduction in hazards of antibiotic prescriptions was for time-varying cotrimoxazole preventive therapy (HR = 0.57; 95% CI, 0.52-0.61). Additionally, maternal ARV regimens (HR = 0.85; 95% CI, 0.78-0.93) and infants’ nevirapine use (HR = 0.90; 95% CI, 0.82-0.98) were both associated with a reduced hazard of antibiotic drug prescription. The researchers also said that as infants aged, their chances of receiving antibiotic prescriptions declined.

“With the expansion of lifelong ART coverage in Malawi and other areas of high HIV prevalence and the increasing availability of effective vaccines, HIV-exposed, uninfected infants in Malawi may experience fewer infectious diseases and a resulting decrease in prescription of antibacterial drugs,” Ewing and colleagues wrote. “Our study provides a useful reference point for measuring prescription of antibacterial drugs for infants at high risk for infectious diseases in a low-income country and for assessing the effects of programs to improve the health of those infants in Malawi.” – by Katherine Bortz

Disclosure: Infectious Diseases in Children was unable to confirm relevant financial disclosures at the time of publication.