High antibiotic exposure among children in low- and middle-income countries

Dr. Gillian Levine

Schweizerisches Tropen- und Public Health-Institut, Allschwil
Universität Basel
Universitäts-Kinderspital beider Basel (UKBB)

PD Dr. Julia Bielicki

Universitäts-Kinderspital beider Basel (UKBB)
St Georgeʹs, University of London

Appropriate antibiotic treatment for children with infections prevents mortality and severe illness. On the other hand, antibiotics increase the risk of allergic, inflammatory and metabolic disorders and widespread antibiotic use has contributed to rising antimicrobial resistance. Few estimates of total antibiotic exposure among children in low- and-middle-income countries (LMICs) are available. 

The goal of the study of Gillian A. Levine and Julia A. Bielicki was to estimate the total number of antibiotic treatments among children in LMICs in the first five years of life. They aimed to describe antibiotic treatment patterns by age, illness, and country. Moreover, they characterized antibiotic use practices in medical care settings and due to self-medication. To estimate the average number of antibiotic treatments children received in the first five years of life in 45 LMICs (countries from Africa, Asia, Central America, Caribbean), the researchers analyzed Demographic and Health Survey (DHS) data. They determined the two-week prevalence of fever, diarrhea or cough and antibiotic treatment rates for these illnesses in children aged 0 to 59 months and modeled the cumulative antibiotic treatment over the first five years of life for each country. 

The two scientists identified large differences between countries in terms of antibiotic use: The proportion of illness episodes treated with antibiotics ranged from 10% (Niger) to 72% (Jordan). A mean of 42,7% of fever cases and 32,9% of illness episodes without fever received antibiotics. The researchers estimated that children in LMICs received a median of 18,5 antibiotic treatments during their first five years of life. The average number of antibiotic treatments in the first five years of life ranged from 3,7 in Niger to 38,6 in DR Congo. An average of 9% of antibiotic treatments was attributable to informal care and 17% to self-medication. 

The study shows a high and, in some cases likely unjustified, use of antibiotics in young children in LMICs. These observations are concerning since antibiotic resistance is increasing while access to life-saving antibiotics still appears limited in some LMICs. Therefore, specific policies and tools are needed – both to reduce the inappropriate use of antibiotics, and to improve access to appropriate treatment.

Cumulative Antibiotic Exposure in the First Five Years of Life: Estimates for 45 Low- and Middle-income Countries from Demographic and Health Survey Data. Gillian Levine, Julia Bielicki, Günther Fink. Clin Infect Dis. 2022 Oct 29;75(9):1537-1547.