Christian Medical College, Vellore, India.
National Institute for Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India.
J Infect Dis. 2021 Nov 23;224(Supple 5):S494-S501. doi: 10.1093/infdis/jiab115.
Acute febrile illness in children is frequently treated with antibiotics. However, the inappropriate use of antibiotics has led to the emergence of multidrug-resistant pathogens.
We measured use of antibiotics for fever in 4 pediatric cohorts that were part of the Surveillance for Enteric Fever in India (SEFI) network. In this network, 24 062 children were followed up weekly, capturing information on fever and other morbidity between October 2017 and December 2019.
An antibiotic was given in 27 183 of the 76 027 (35.8%) episodes of fever. The incidence of fever-related antibiotic use was 58.0 (95% confidence interval [CI], 57.2-58.6) per 100 child-years. The median time to initiation of antibiotics was 4 days, and in 65% of those who received an antibiotic it was initiated by the second day. Antibiotics were continued for <3 days in 24% of the episodes. Higher temperature, younger age, male sex, joint family, higher education, internet access, and availability of personal conveyance were associated with antibiotic treatment for fever.
In developing countries where antibiotic use is not regulated, broad-spectrum antibiotics are initiated early, and often inappropriately, in febrile illness. Frequent and inappropriate use of antibiotics may increase risk of antimicrobial resistance.
儿童急性发热常采用抗生素治疗。然而，抗生素的不恰当使用导致了多药耐药病原体的出现。
我们测量了参与印度肠热病监测（SEFI）网络的 4 个儿科队列中儿童发热时抗生素的使用情况。在该网络中，24062 名儿童每周进行随访，记录 2017 年 10 月至 2019 年 12 月期间发热和其他疾病的信息。
在 76027 例发热事件中的 27183 例（35.8%）使用了抗生素。发热相关抗生素使用的发生率为 58.0（95%置信区间[CI]，57.2-58.6）/100 儿童年。抗生素开始使用的中位时间为 4 天，其中 65%的人在第二天开始使用抗生素。24%的发热事件中抗生素使用时间<3 天。较高的体温、较小的年龄、男性、联合家庭、较高的教育水平、互联网接入和个人交通工具的可用性与发热的抗生素治疗有关。
在抗生素使用不受监管的发展中国家，广谱抗生素在发热疾病中被早期且经常不恰当地使用。抗生素的频繁和不恰当使用可能会增加抗菌药物耐药的风险。
