Ercumen Ayse, Mertens Andrew N, Butzin-Dozier Zachary, Jung Da Kyung, Ali Shahjahan, Achando Beryl S, Rao Gouthami, Hemlock Caitlin, Pickering Amy J, Stewart Christine P, Tan Sophia T, Grembi Jessica A, Benjamin-Chung Jade, Wolfe Marlene, Ho Gene G, Rahman Md Ziaur, Arnold Charles D, Dentz Holly N, Njenga Sammy M, Meerkerk Theodora, Chen Belinda, Nadimpalli Maya, Islam Mohammad Aminul, Hubbard Alan E, Null Clair, Unicomb Leanne, Rahman Mahbubur, Colford John M, Luby Stephen P, Arnold Benjamin F, Lin Audrie
Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA.
Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
Nat Commun. 2025 Jan 9;16(1):556. doi: 10.1038/s41467-024-55801-x.
Antibiotics can trigger antimicrobial resistance and microbiome alterations. Reducing pathogen exposure and undernutrition can reduce infections and antibiotic use. We assess effects of water, sanitation, handwashing (WSH) and nutrition interventions on caregiver-reported antibiotic use in Bangladesh and Kenya, longitudinally measured at three timepoints among birth cohorts (ages 3-28 months) in a cluster-randomized trial. Over 50% of children used antibiotics at least once in the 90 days preceding data collection. In Bangladesh, the prevalence of antibiotic use was 10-14% lower in groups receiving WSH (prevalence ratio [PR] = 0.90 (0.82-0.99)), nutrition (PR = 0.86 (0.78-0.94)), and nutrition+WSH (PR = 0.86 (0.79-0.93)) interventions. The prevalence of using antibiotics multiple times was 26-35% lower in intervention arms. Reductions were largest when the birth cohort was younger. In Kenya, interventions did not affect antibiotic use. In this work, we show that improving WSH and nutrition can reduce antibiotic use. Studies should assess whether such reductions translate to reduced antimicrobial resistance.
抗生素会引发抗菌药物耐药性和微生物群落改变。减少病原体暴露和营养不良可减少感染及抗生素使用。我们在一项整群随机试验中，对孟加拉国和肯尼亚出生队列（3至28个月大）在三个时间点纵向测量的水、环境卫生、洗手（WSH）和营养干预措施对照顾者报告的抗生素使用情况的影响进行了评估。在数据收集前的90天内，超过50%的儿童至少使用过一次抗生素。在孟加拉国，接受WSH干预（患病率比[PR]=0.90(0.82 - 0.99)）、营养干预（PR = 0.86(0.78 - 0.94)）以及营养+WSH联合干预（PR = 0.86(0.79 - 0.93)）的组中，抗生素使用患病率降低了10 - 14%。干预组中多次使用抗生素的患病率降低了26 - 35%。出生队列年龄越小，降幅越大。在肯尼亚，干预措施未影响抗生素使用。在这项研究中，我们表明改善WSH和营养状况可减少抗生素使用。研究应评估这种减少是否会转化为抗菌药物耐药性的降低。
