Manikam, L;
Lakhanpaul, M;
Schilder, AG;
Littlejohns, P;
Cupp, MA;
Alexander, EC;
Hayward, A;
(2020)
Effect of antibiotics in preventing hospitalizations from respiratory tract infections in children with Down syndrome.
Pediatric Pulmonology
10.1002/ppul.25100.
(In press).
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Abstract
BACKGROUND: Children with Down Syndrome (DS) are at high risk of respiratory tract infections (RTIs) due to anatomical variations, comorbidities and immune system immaturity. Evidence on interventions to reduce this risk is incomplete. This study aims to quantify the effect of antibiotics prescribed for RTIs in primary care on the subsequent risk of RTI-related hospitalisation for children with DS versus controls. METHODS: We conducted a retrospective cohort study of 992 children with DS and 4,874 controls managed by UK National Health Service (NHS) General Practitioners (GPs) and hospitals as identified in CALIBER (Clinical disease research using LInked Bespoke studies and Electronic health Records), 1997-2010. Univariate and multivariate logistic regression were undertaken. RESULTS: In children with DS, the prescription of antibiotics following an RTI-related GP consultation did not significantly reduce the risk of RTI-related hospitalisation in the subsequent 28 days (Risk with antibiotics 1.8%; without 2.5%; Risk Ratio (RR) 0.699, 95% Confidence Interval (CI) 0.471-1.036). Subgroup analyses showed a risk reduction only in infants with DS, after adjustment for covariates. There was no reduction in risk for controls, overall or across subgroups. CONCLUSIONS: In conclusion, whilst prescription of antibiotics following RTI-related GP consultations were effective for infants with DS in reducing subsequent RTI-related hospitalisation, this was not the case for older children with DS. We would encourage further high-quality cohort and randomised controlled trials to interrogate this finding, and to examine the impact of antibiotics on other endpoints, including symptom duration. This article is protected by copyright. All rights reserved.
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