Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia.
Department of Paediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Amsterdam, The Netherlands.
J Antimicrob Chemother. 2024 Jun 3;79(6):1289-1293. doi: 10.1093/jac/dkae090.
Antibiotic exposure increases antimicrobial resistance and has also been associated with long-term harms, including allergies, inflammatory diseases and weight gain. We assessed antibiotic exposure in the first 2 years of life in Australian children, the factors influencing this and its appropriateness.
Data from 1201 participants in the MIS BAIR randomized controlled trial were used. Multivariable logistic regression was used to identify factors associated with antibiotic exposure.
At 1 and 2 years of age, exposure to at least one course of antibiotics was 43% and 67%, with the highest first antibiotic prescription rate between 9 and 18 months. Amoxicillin was the most frequently used antibiotic (59%), followed by cefalexin (7%). The most common diagnoses for which antibiotics were prescribed were respiratory tract infections from 0 to 6 months of age and otitis media from 6 to 12 months. Factors associated with antibiotic exposure from 0 to 12 months of age were delivery by Caesarean section (adjusted odd-ratio (aOR) 1.5, 95%CI 1.1-1.9), birth in winter (aOR 1.7, 95%CI 1.2-2.4), maternal antibiotic exposure during the last trimester of pregnancy (aOR 1.6, 95%CI 1.1-2.3), cessation of breastfeeding by 6 months of age (aOR 1.5, 95%CI 1.1-2.0) and day-care attendance (aOR 1.4, 95%CI 1.1-1.8). Based on parent-reported questionnaires, 27% of infants were treated in the first year of life for conditions unlikely to need antibiotic treatment.
At least two-thirds of children were prescribed antibiotics in the first 2 years of life, and more than a quarter of these exposures may have been unnecessary.
抗生素的使用会增加抗药性，还与长期危害有关，包括过敏、炎症性疾病和体重增加。我们评估了澳大利亚儿童生命最初 2 年内的抗生素使用情况、影响因素及其合理性。
利用 MIS BAIR 随机对照试验的 1201 名参与者的数据。采用多变量逻辑回归分析确定与抗生素使用相关的因素。
1 岁和 2 岁时，至少使用过一次抗生素的比例分别为 43%和 67%，9 至 18 个月时首次使用抗生素的比例最高。使用最频繁的抗生素是阿莫西林（59%），其次是头孢氨苄（7%）。0 至 6 个月时最常见的抗生素处方诊断为呼吸道感染，6 至 12 个月时为中耳炎。0 至 12 个月时与抗生素使用相关的因素包括剖宫产（调整比值比（aOR）1.5，95%CI 1.1-1.9）、冬季出生（aOR 1.7，95%CI 1.2-2.4）、母亲在妊娠最后三个月使用抗生素（aOR 1.6，95%CI 1.1-2.3）、6 个月时停止母乳喂养（aOR 1.5，95%CI 1.1-2.0）和上日托（aOR 1.4，95%CI 1.1-1.8）。根据父母报告的问卷，27%的婴儿在生命的第一年因不太可能需要抗生素治疗的疾病接受了治疗。
至少三分之二的儿童在生命的头 2 年内被开具了抗生素，其中超过四分之一的抗生素使用可能是不必要的。
