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Effect of antibiotics in preventing hospitalizations from respiratory tract infections in children with Down syndrome.

UCL Institute of Epidemiology and Health Care, University College London, London, UK. UCL Institute of Health Informatics Research, University College London, London, UK. Population, Policy & Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK. Whittington Health NHS Trust, London, UK. National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK. evidENT, UCL Ear Institute, University College London, London, UK. Centre for Implementation Science, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK. Paediatric Liver, GI and Nutrition Centre and MowatLabs, King's College Hospital, Denmark Hill, London, UK.

Pediatric pulmonology. 2021;(1):171-178
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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 hospitalization for children with DS versus controls. METHODS We conducted a retrospective cohort study of 992 children with DS and 4874 controls managed by UK National Health Service 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 hospitalization in the subsequent 28 days (risk with antibiotics, 1.8%; without, 2.5%; risk ratio, 0.699; 95% confidence interval, 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, while prescription of antibiotics following RTI-related GP consultations were effective for infants with DS in reducing subsequent RTI-related hospitalization, this was not the case for older children with DS. We would encourage further high-quality cohort and randomized controlled trials to interrogate this finding, and to examine the impact of antibiotics on other endpoints, including symptom duration.