Antibiotic usage in the first year of life in HIV-exposed, uninfected infants in Malawi: Results from the Breastfeeding, Antiretrovirals and Nutrition (BAN) Study
Athena P. Kourtis, Alexander C. Ewing, Nicole L. Davis, Dumbani Kayira, Mina C. Hosseinipour, Charles van der Horst, Denise J. Jamieson for the BAN study team
Background: Antibiotic resistance is a serious health hazard driven by overuse. Antibiotic usage in low-income countries is poorly studied. HIV-exposed, uninfected (HEU) infants are a growing population at high risk for infection and resulting antibiotic use.
Methods: We described antibiotic usage among 2,152 HEU infants in the Breastfeeding, Antiretrovirals and Nutrition (BAN) Study in Lilongwe, Malawi, 2004-2010. Factors were tested for associations with antibiotic prescription using a repeated measures Cox proportional hazards model and included cotrimoxazole preventive therapy (CPT) exposure, malaria season, antiretroviral (ARV) treatment, receipt of maternal nutritional supplement, maternal CD4+ T-cell count, HIV viral load, maternal age, infant sex and birthweight.
Results: Overall, 80% of HEU infants in the BAN study received an antibiotic prescription during follow-up (median length: 336 days). The majority (67%) of the 5,107 antibiotic prescriptions were for respiratory indications. Penicillins (43%) were the most commonly prescribed type of antibiotics, followed by sulfonamides (23%). The median number of prescriptions received per infant-month was 0.2 (interquartile range (IQR): 0.1, 0.3). Factors associated with lower hazard of antibiotic prescription included CPT exposure (hazard ratio (HR): 0.57 [95% confidence interval (CI): 0.52, 0.61]), maternal ARV (HR: 0.85, 95% CI: [0.78, 0.93]), and infant ARV (HR: 0.90, 95% CI: [0.82, 0.98]). Hazard of antibiotic prescription also decreased as participants aged (HR for ages 6-12 months vs. 0-1 month: 0.48, 95% CI: [0.40, 0.58]). Male sex (HR: 1.09, 95% CI: [1.02, 1.17]) and log maternal viral load (copies/mL) (HR: 1.02, 95% CI: 1.003, 1.04) were associated with increased hazard of antibiotic prescription.
Conclusion: This study provides an estimate of antibiotic use by HEU infants in a low-income country and evidence that CPT may lead to reduced antibiotic use.
N. Davis, None
D. Kayira, None
M. Hosseinipour, None
C. Van Der Horst, None
D. Jamieson, None
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