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Australian Babies Given Antibiotics at Some of the Highest Rates in the World

Australian babies are prescribed antibiotics at some of the highest rates in the world, risking possible long-term side-effects and speeding up antibiotic resistance in the community, which has been described by the World Health Organisation as a “global health emergency”.

In the first study of its kind, researchers tracked antibiotic use in 660 children under the age of one, both prescribed by GPs, and administered in hospitals.

Half of the babies tracked were were given antibiotics in the first year of life, many for conditions the researchers said did not need antibiotics.

More than a quarter of the children were given multiple antibiotic prescriptions before they reached the age of one, with the average number of prescriptions being almost one (0.91) prescription of antibiotics for every child in the group.

That rate puts Australia near the very top among high-income countries where data is available. Of those comparable countries, only Italy had a higher rate, and Australia’s rate was almost 500% the rate seen in Switzerland and 150% the UK rate.

Of the eight similar countries with data available, only Italy had a higher rate than Australia, with an average of 1.3 prescriptions per baby, according to the work published today in the Journal of Paediatrics and Child Health by researchers at the Murdoch Children’s Research Institute and Deakin University.
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Average Prescription per Child in the First Year of Life

 


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“It was surprising that so many children got antibiotics,” said David Burgner from Murdoch Children’s Research Institute, who led the research.

“The thing that surprised me particularly was how we compared with other similarly affluent countries,” he said.

Viral upper respiratory tract infections and bronchiolitis accounted for almost a fifth of the prescriptions, despite antibiotics not helping those conditions.

“They’re very common and antibiotics won’t make any difference,” Burgner said.

The most common reason for the prescription was ear infection, for which antibiotics do not appear to be very effective, even when a bacteria is involved. Current Australian guidelines recommend against immediate antibiotic use in most cases.

The overprescription of antibiotics was a worry, said Burgner, because of long term consequences for the community and the child.

“We know that the more people who are exposed to antibiotics, the more bacteria are likely to become resistant,” he said.

The World Health Organisation has labelled antimicrobial resistance a “global health emergency”.

Experts have warned that as the problem increases, lifesaving treatments such as chemotherapy and organ transplants, as well as routine operations such as caesareans and hip replacements will be potentially fatal.

But there were also emerging clues suggesting antibiotics could affect the long-term health of the children who receive them too.

“The thing to think about is how the antibiotics affect the child’s microbiome – the organisms that live in our gut and skin. There is increasing evidence that the microbiome, especially early in life is important in longer term health risks – allergy, asthma and cardiovascular disease. We don’t fully understand it but something that has a powerful effect on the microbiome early in life might have longterm consequences.”

Many of the prescriptions were completely appropriate, and in line with evidence-based treatment, Burgner said. Those included prescriptions for pneumonia, whooping cough and suspected sepsis.

He said it was important to educate both GPs and parents about the appropriate use of antibiotics.

“One of the most important things that parents can do is make sure their children are fully vaccinated. That really takes a number of potentially life threatening infections out of the equation because they’ll be protected by the vaccines.”

Peter Collignon, an infectious disease physician and microbiologist at the Australian National University said there was a culture in Australia where doctors and patients demanded a pill to fix conditions, even when none existed.

“Countries with a lot worse climate than us – like the Netherlands and Sweden and Denmark – do very well by giving half the antibiotics and without any detrimental effect to people,” Collignon said.

“The doctors are a reflection of society – the fact we over prescribe antibiotics is a reflection of our view in society.

“You have to have a culture shift in the whole of society,” he said. “I look at smoking and there is a vast difference in our acceptance of smoking compared to 30 years ago. That’s a cultural change – an attitude change.”

Evan Ackermann, from the Royal Australian College of General Practitioners, which represents GPs, defended the prescribing rates.

“The first year of life is a time when the immune system is immature – a known problem in infants,” Ackermann said.

“As the cause of an illness is often difficult to define, doctors would employ a high safety margin when considering antibiotics for respiratory tract infections.”

He said the study “presented no data on health outcomes, sickness experienced, or whether or not prescribing an antibiotic caused problems.

“While the study assesses the issues surrounding prescribing antibiotics, it doesn’t analyse the benefits and harms of antibiotics for infants in this age group.”

Earlier this year other researchers found Australian GPs were prescribing antibiotics for acute respiratory infections at between four and nine times the rate recommended by official guidelines.
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