Reduction in diarrheal rates through interventions that prevent unnecessary antibiotic exposure early in life in an observational birth cohort
Published Date:Nov 30 2015
Source:J Epidemiol Community Health. 70(5):500-505.
Pubmed Central ID:PMC5030489
Funding:1-R56-AI108515/AI/NIAID NIH HHS/United States
5-R01-AI072222/AI/NIAID NIH HHS/United States
5-T32-AI070114-08/AI/NIAID NIH HHS/United States
D43 TW007392/TW/FIC NIH HHS/United States
D43-TW007392/TW/FIC NIH HHS/United States
DP2 HD084070/HD/NICHD NIH HHS/United States
DP2-HD084070/DP/NCCDPHP CDC HHS/United States
R01 AI072222/AI/NIAID NIH HHS/United States
R56 AI108515/AI/NIAID NIH HHS/United States
T32 AI070114/AI/NIAID NIH HHS/United States
Antibiotic treatment early in life is often not needed and has been associated with increased rates of subsequent diarrhea. We estimated the impact of realistic interventions, which would prevent unnecessary antibiotic exposures before 6 months of age, on reducing childhood diarrheal rates.
In data from a prospective observational cohort study conducted in Vellore, India, we used the parametric g-formula to model diarrheal incidence rate differences contrasting the observed incidence of diarrhea to the incidence expected under hypothetical interventions. The interventions prevented unnecessary antibiotic treatments for non-bloody diarrhea, vomiting, and upper respiratory infections before 6 months of age. We also modeled targeted interventions, in which unnecessary antibiotic use was prevented only among children who had already stopped exclusive breastfeeding.
More than half of all antibiotic exposures before 6 months (58.9%) were likely unnecessary. The incidence rate difference associated with removing unnecessary antibiotic use before 6 months of age was -0.28 (95% confidence interval: -0.46, -0.08) episodes per 30 child-months. This implies that preventing unnecessary antibiotic exposures in just 4 children would reduce the incidence of diarrhea by one from 6 months to 3 years of age.
Interventions to reduce unnecessary antibiotic use among young children could result in an important reduction in diarrheal rates. This work provides an example application of statistical methods which can further the aim of presenting epidemiologic findings that are relevant to public health practice.
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