Study finds non-prescription antibiotic use high in young children in poorer countries

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Pills in hands of children — showcake / iStock

More than one third of children younger than 5 years old in low- and middle-income countries (LMICs) receive antibiotics without a prescription, researchers reported today in JAC-Antimicrobial Resistance.

In a systematic review and meta-analysis, Ethiopian researchers examined 12 observational studies that addressed antibiotic use without a prescription in children under 5 in LMICs. While the widespread use of antibiotics without a prescription in LMICs is well-documented, no prior systematic review and meta-analysis has been conducted on antibiotic use without a prescription in children under 5 in LMICs, a population that's known to commonly receive antibiotics for community infections that may be self-limiting or caused by viruses.

The 12 cross-sectional studies had a combined sample size of 8,773 participants and were conducted in Africa (6), Asia (3), and South America (3). The pooled prevalence of antibiotic use without a prescription was 33.3% (95% confidence interval [CI], 27.4% to 39.2%), with the highest pooled estimate found among studies from Africa (39.9%; 95% CI, 35.6% to 44.1%) and lowest in studies from South America (28.6%; 95% CI, 24.2% to 33.0%). Among individual countries, the highest prevalence was in Nigeria (46.7%), and the lowest was in China (14.5%).

The analysis also found the most common sources for non-prescription antibiotics were community pharmacies, which is similar to findings from previous studies.

Major factor in emergence, spread of AMR

Antibiotic use without a prescription is considered a major contributing factor in the emergence and spread of antimicrobial resistance (AMR), and it is among the issues that the World Health Organization (WHO) has said should be addressed by antimicrobial stewardship programs. But while stewardship programs have become well-established in developed nations, they haven't been as successfully implemented in LMICs.

The study authors say the findings imply that LMICs should"strengthen their regulatory systems, prevent childhood infections, increase healthcare accessibility, improve health insurance coverage, and enhance awareness of the public concerning the impact of antibiotic use without prescription."

"The results of this study will be crucial for the WHO, the health ministries of the respective countries, regulatory systems and other non-governmental organizations working in child health," they concluded.

Quick takes: Polio in 6 nations, tularemia cases in Nebraska, more H5N1 in US poultry

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Chris Dall, MA

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