Cumulative Antibiotic Exposure in the First 5 Years of Life: Estimates for 45 Low- and Middle-Income Countries From Demographic and Health Survey Data

Abstract

Abstract Background Estimates of the total cumulative exposure to antibiotics of children in low-resource settings, and the source of these treatments, are limited. Methods We estimated the average number of antibiotic treatments children received in the first 5 years of life in 45 low- and middle-income countries (LMICs) using Demographic and Health Survey data. The 2-week point prevalence of fever, diarrhea, or cough and antibiotic treatment for these illnesses were estimated for ages 0–59 months and aggregated to estimate cumulative illness and antibiotic treatment for each country. We estimated treatment rates and contribution to total antibiotic use attributable to medical care, informal care, and self-medication. Results Forty-five countries contributed 438 140 child-observations. The proportion of illness episodes treated with antibiotics ranged from 10% (95% confidence interval [CI], 9%–12%]) in Niger to 72% (95% CI, 69%–75%) in Jordan. A mean of 42.7% (95% CI, 42.1%–43.3%) of febrile and 32.9% of nonfebrile (95% CI, 32.4%–33.5%) illness episodes received antibiotics. In their first 5 years, we estimate children received 18.5 antibiotic treatments on average (interquartile range [IQR], 11.6–24.6) in LMICs. Cumulative antibiotic exposure ranged from 3.7 treatments in Niger (95% CI, 2.8%–4.6%) to 38.6 treatments in the Democratic Republic of Congo (95% CI, 34.7%–42.4%). A median of 9.0% of antibiotic treatments was attributable to informal care (IQR, 5.9%–21.2%), and 16.9% to self-medication (IQR, 9.5%–26.2%). Conclusions Childhood antibiotic exposure is high in some LMICs, with considerable variability. While access to antibiotics for children is still not universal, important opportunities for reducing excess use also exist, particularly with respect to the informal care sector and self-medication.