Children given antibiotics which should only be used sparingly

Children given antibiotics which should only be used sparingly

Originally published on The Telegraph

Children are too often being prescribed antibiotics that have been put on a list of treatments that should only be used sparingly because of fears of the development of superbugs. 

An analysis of sales in the community of oral antibiotics specially formulated for children in 70 high and middle-income countries has found that consumption of the drugs varies widely from country to country.

In a quarter of all countries antibiotics which should only be used under certain strict circumstances accounted for 20 per cent of total antibiotic consumption.

The analysis, published in the journal Lancet Infectious Diseases, also found that the drug amoxicillin, an antibiotic to treat the most common childhood infections, is used at relatively low levels.

In 2017, the World Health Organization grouped antibiotics into three categories – access, watch and reserve. The list was developed to ensure that the right antibiotics are used in the right circumstances, as well as reducing the development of drug-resistant bacteria and preserving the effectiveness of ‘last-resort’ antibiotics when all others fail.

This is the first time that researchers have looked at consumption of antibiotics among children outside hospital and they hope that their findings will help countries improve their prescribing practices.

The report found that in 76 per cent of cases antibiotics on the "access" list  were used. But some countries have very high use of drugs that are on the "watch" list.

In China, more than half - 54 per cent - of antibiotics prescribed to children are on the “watch” list. Japan is not far behind with 51 per cent of antibiotics prescribed in this category, followed by India at 47 per cent and Bangladesh at 44 per cent.  

In the UK, just 12 per cent of antibiotics prescribed to children are on the watch list.

The use of amoxicillin in the community is also quite low accounting for just 31 per cent of antibiotics used, despite the fact that it should be the first choice for most common infections treated by GPs.

Some 11 countries used amoxicillin in less than 10 per cent of cases, the review found.

Dr Julia Bielicki, senior lecturer in paediatric infectious diseases at St George’s, University of London, said it was unclear why there was such a low use of amoxicillin by countries.

She said many countries use co-amoxicillin almost as much as amoxicillin - this drug is also on the access list but for respiratory tract infections, the commonest childhood infection, amoxicillin was the most appropriate treatment, she said. 

"Co-amoxicillin is only listed by WHO as first choice for severe pneumonia when you want to be sure that you are treating all possible pathogens. For the more common middle-ear infection amoxicillin is clearly listed as the first choice," she said.

Co-amoxicillin is a broader spectrum drug, meaning that it targets a wider number of bacteria. It is also more likely to lead to side effects, such as diarrhoea, than amoxicillin. Experts believe that its use is more likely to lead to antibiotic resistance, although data on this is sparse, added Dr Bielecki. 

Dr Manica Balasegaram, executive director of the Global Antibiotic Research and Development Partnership, which supported the research, said: “WHO strongly encourages use of ‘access’ antibiotics to treat the majority of infections for children and adults as they are affordable, generally less toxic and less likely to drive future antibiotic resistance.”

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