Pediatric Patients with Asthma Overprescribed Antibiotics

Children with asthma twice as likely to receive antibiotics.

Antibiotic-resistance is posing an increasing threat to global health, as more bacteria are developing resistance against common treatments. Health organizations have urged healthcare providers to cut back on antibiotic prescriptions and for patients to take the drugs as advised.

Children with asthma may be more likely to receive antibiotics, despite not being more likely to have an infection than children without the condition, according to a study presented at the European Respiratory Society International Congress.

Antibiotic overuse in children can be potentially dangerous, since they might be at greater risk of experiencing a future drug-resistant infection.

"Inappropriate use of antibiotics can be bad for individual patients and the entire population, and makes it harder to control the spread of untreatable infections,” said lead researcher Esmé Baan, MD.

The authors believe that asthma symptoms may be incorrectly identified as a respiratory tract infection and treated with antibiotics as a prevention method, according to the study.

"Asthma is a common and ongoing condition, and it has symptoms that could be mistaken for a respiratory tract infection,” Dr Baan said. “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.”

Included in the study were 1.5 million pediatric patients from the UK, including 150,000 patients with asthma. Another 375,000 children from the Netherlands were included, of whom 30,000 were diagnosed with asthma. The authors examined prescription drug data for all patients.

The authors found that children with asthma were 1.6 times more likely to receive antibiotics compared with those without the condition, according to the study. Specifically, in the UK, prescription rates were nearly 2 times higher among the populations.

In the Netherlands, there were 197 prescriptions per 1000 children with asthma annually, while it was 126 prescriptions per 1000 controls, according to the study. Similarly, there were 374 prescriptions per 1000 children with asthma each year in the UK compared with 250 per 1000 controls.

The authors note that since overprescribing was high among children with asthma living in both countries, it is likely to be common in other countries, especially since the Netherlands has a low overall rate of antibiotic use.

"Antibiotics should only be given when there is clear evidence of a bacterial infection such as for pneumonia. However, we saw that, in children with asthma, most of the antibiotic prescriptions in children were intended for asthma exacerbations or bronchitis, which are often caused by a virus rather than bacteria,” Dr Baan said. “It can be difficult for a GP [general practioner] to differentiate between a deterioration in asthma symptoms and a bacterial respiratory infection. We think this might be leading to more antibiotic prescriptions in children with asthma.”

Overprescribing antibiotic resistance may further spread drug-resistant bacteria, which can pose serious risks to patients with asthma.

"Children with uncontrolled asthma can face difficulties over several years, for example it can affect their ability to play and take part in sports, they may have more days off school, or experience disturbed sleep. We don't want to compound this with prescribing drugs that won't help and may be harmful,” Dr Baan concluded. "Of course, sometimes antibiotics are needed, but we should be careful and only prescribe them when they are really required. In general, we should discourage GPs from prescribing unnecessary antibiotics or run the risk of more drug-resistant infections in the future.”