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Antibiotics Still Being Inappropriately Prescribed in Asthma Patients

As practitioners continue to mistake the worsening of asthma symptoms for bacterial respiratory infections, more antibiotics are being prescribed, many times, inappropriately.

Researchers from Erasmus University, in Rotterdam, The Netherlands, have found that an exorbitant number of children with asthma are being prescribed unnecessary antibiotics. In a time of growing antibiotic resistance, this news is particularly disheartening.

According to the study, presented at the European Respiratory Society International Congress 2017 on September 12, 2017, many practitioners are mistaking the signs of symptoms of asthma for a respiratory infection, and thus, are prescribing antibiotics. This is despite the fact that current guidelines do not support this practice. Study author Esmé Baan, MD, from the department of medical informatics at Erasmus elaborated on this in a press release, stating, “Asthma is a common and ongoing condition, and it has symptoms that could be mistaken for a respiratory tract infection. However, international and national guidelines clearly state that antibiotics should not be given for a deterioration in asthma symptoms, because this is rarely associated with a bacterial infection.”

For the study, the researchers looked at antibiotic prescription data for 1.5 million children from the United Kingdom (about 150,000 of whom had asthma), and 375,000 children from The Netherlands (of whom, about 30,000 had asthma). International guidelines on asthma treatment are the same for both regions: “antibiotic use for asthma exacerbations is generally not indicated,” according to the press release.

The prescribing data for children with asthma was then compared with those who did not have asthma. The study authors also compared data across regions. Results showed that those children with asthma were about “1.6 times more likely to be prescribed antibiotics, compared to children who do not have asthma.” Rates of antibiotics prescriptions were almost twice as high in the UK (374 prescriptions / 1000 children with asthma per year) compared with The Netherlands (197 antibiotic prescriptions / 1000 children with asthma per year). Similar rates were seen among prescriptions for children without asthma, with practitioners in the UK writing 250 prescriptions / 1000 children without asthma, and those in The Netherlands writing 126 prescriptions / 1000 children without asthma. The most commonly prescribed antibiotic was amoxicillin.

The researchers highlight in the study that, “since the pattern of overprescribing antibiotics to children with asthma was the same in both countries, the situation is likely to be the same elsewhere.” Perhaps even more startling is that “The Netherlands has some of the lowest antibiotic use in the world, so the situation in other countries where antibiotic use is much higher, such as in Italy, Spain, Portugal and Greece, could potentially be far worse,” according to the press release.

This is not the first-time inappropriate prescribing of antibiotics for asthma has been highlighted in the literature. In June 2017, researchers from the UK published the results of the Azithromycin Against Placebo in Exacerbation of Asthma (AZALEA) study, which showed that there are no clinical benefits from adding azithromycin (500 mg for 3 days) to standard treatment for adults who presented to emergency departments with acute asthma exacerbations requiring a corticosteroid course. The randomized, double-blind, placebo-controlled clinical trial was carried out from September 2011 to April 2014 at 31 United Kingdom medical centers and included 199 patients after screening 4582 subjects.

In the AZALEA study, the researchers found that antibiotics were also used for acute asthma exacerbations, much like the Erasmus study. According to the authors of both studies, these studies indicate and identify important opportunities for antibiotic stewardship.