Over-prescription of antibiotics puts children in poor countries at risk, says Lancet study

Children in low-and middle-income countries (LMICs) are receiving an average of 25 antibiotic prescriptions during their first five years of life—an amount so excessive that it could harm their ability to fight pathogens, and also increase antibiotic resistance worldwide, according to a study.

Earlier studies have revealed that antimicrobial resistance is responsible for thousands of deaths each year globally, and unless urgently addressed, it may cause more than 10 million people to die every year by 2050.

The researchers, including those from Harvard University in the US, said one major factor contributing to this global health crisis is the excessive use of antibiotics worldwide.

They said while detailed information about antibiotic use in high-income countries is available, little is known regarding the consumption and exposure of these drugs among children in low- and middle-income countries (LMICs).

Citing an example, they said, in the African country of Tanzania, more than 90 per cent of children who visit a health care facility receive an antibiotic, although only in about a fifth of these cases treatment was actually required.

In the first-of-its-kind study, published in the journal The Lancet Infectious Diseases, the researchers looked at the total antibiotic prescription given for children under the age of five in eight LMICs—including Nepal, Namibia, Kenya, and Haiti.

"What is unique about this study is that it provides a much more comprehensive picture of pediatric antibiotic exposure in LMICs than what has been reported previously. It combines both household data on where and when children are brought for care with data from direct observations of health care workers caring for sick children," said Jessica Cohen, study co-author and an associate professor at Harvard University.

Their study revealed that, on average, children in these countries received 25 antibiotic prescriptions through age five.

According to the researchers, this is a "remarkable" estimate, given that two antibiotic prescriptions per year is considered excessive in many high-income settings.

The results showed that, on average, antibiotics were administered in nearly four out of every five cases for children with a respiratory illness, in 50 per cent of cases for children with diarrhea, and in 28 per cent for children with malaria.

However, the researchers said this number varied between countries.

While a child in Senegal received approximately one antibiotic prescription per year in the first five years of life, a child in Uganda was prescribed up to 12, they added.

Citing a prior study for comparison, they said, children under five in Europe receive less than one antibiotic prescription per year on average.

"This number is still high given that the vast majority of infections in this age group are of viral origin," said Valerie D'Acremont, a study co-author from the Swiss Tropical and Public Health Institute in Switzerland.

The scientists cautioned that excess antibiotic use can destroys the natural gut flora—essential to fighting pathogens—in children.