Non-prescription antibiotic use in children is an understudied problem. This practice includes obtaining and taking antibiotics without a prescription (e.g., from stores or flea markets in the United States (U.S.) or abroad), taking another person?s antibiotics, or taking one?s own stored antibiotics for an indication other than for which the antibiotic was originally prescribed. In our 2019 scoping review, we found only three studies exploring non- prescription antibiotic use in children in the U.S. One of these studies was a 2018 national internet survey, finding that 92% of surveyed parents had leftover pediatric antibiotics from previous prescriptions and 73% stated that they subsequently gave the antibiotics to the child?s siblings, unrelated children, parents themselves and unrelated adults. Our scoping review generated considerable press interest, as the problem has barely been described in the U.S. Non-prescription use increases the risk of development of antibiotic resistance, adverse drug reactions, and other harms. Children are more vulnerable to the problem of resistance, as they have a higher incidence of infections and receive more antibiotics than adults. In addition, many antibiotics have not been approved for pediatric use, thus limiting treatment options. Antibiotic use in children has also been associated with an increased risk of asthma, obesity, juvenile idiopathic arthritis, and reduced microbiome diversity. Low-income populations are at higher risk of developing antibiotic-resistant infections, putting low income children at further risk. There is a critical need to study the prevalence, sources and characteristics of non-prescription use in children to guide development of a stewardship intervention. The overall objective of this project is to study the prevalence and predictors of pediatric non-prescription use in racially/ethnically diverse caregivers of children under 18 years in safety net clinics and lay the foundation for our subsequent intervention. We will use the Kilbourne et al. conceptual framework for advancing health disparities research to identify the predictors of non-prescription use.
In Aim 1 A, we will administer a survey in English and Spanish to children?s caregivers to estimate the prevalence of giving non-prescription antibiotics to children. We will explore antibiotics obtained from a range of sources, including stores in the U.S. or other countries, leftover prescribed courses, and family or friends. We will also investigate symptoms that trigger non-prescription use in children, specific antibiotics used, duration of use and storage of pediatric antibiotics.
In Aim 1 B, we will assess how caregivers? sociodemographic factors and health literacy are associated with decisions to use non-prescription antibiotics. Our team includes an epidemiologist, an infectious diseases physician, and a pediatrician working in our safety net pediatric clinics. The proposed research is innovative, because it will provide understanding of the prevalence and characteristics of this unsafe antibiotic use in children. The research is significant, because it will inform understanding of disparities in safe use of antibiotics in children and support development of an intervention to reduce harms associated with non-prescription use.
Children who are given antibiotics without a health care provider?s guidance are at risk for development of antibiotic-resistant infections, allergic reactions, disturbance of normal gut flora, and other harms. We plan to survey children?s caregivers about why they might give non-prescription antibiotics to their children and how often this practice occurs. The information we gain will help us design an intervention to ensure that children receive antibiotics safely and only when necessary.
