In the UK, family doctors conduct over 300 million consultations annually, at least a quarter of which are for children. Of these "paediatric" consultations, approximately two-thirds are for coughs, sore throats, or earaches—conditions commonly grouped under the umbrella term "acute respiratory infections" (ARIs). ARIs are considered "self-limiting" infections, meaning they resolve on their own, and antibiotics are of little or no benefit in such cases. However, 30% of "paediatric" consultations result in antibiotic prescriptions, amounting to approximately 13 million unnecessary antibiotic prescriptions per year. The problem lies not only in the unnecessary expense but also in the direct harm antibiotics cause to children.

A recent British study involving 250,000 children found that preschool-aged children who received two or more courses of antibiotics for ARIs within a year had a 30% higher risk of not responding to subsequent courses of antibiotics compared to children who did not receive antibiotics within a year. The study excluded children with chronic medical conditions that made them more vulnerable to ARIs.

It's well known that irrational use of antibiotics increases the risk of bacterial resistance. However, people believe that resistance only develops when antibiotics are used very frequently, for very long periods, or when they are used in weakened patients. This is incorrect.

Any antibiotic use (whether prescribed or not) increases the risk of bacterial resistance. Studies have shown that even relatively low doses of antibiotics impact children's health. Considering that many preschoolers experience multiple ARIs throughout the year and, consequently, take antibiotics repeatedly, the situation becomes even more dangerous.

There's no explanation yet as to why children who have received antibiotics become less responsive to subsequent courses of antimicrobial therapy. This may be due to the development of antibiotic resistance in the pathogens that cause acute respiratory infections. The problem may also lie in the disruption of the child's gut microbiome. Furthermore, it may be due to parents' unrealistic expectations of subsequent courses of antibiotics: they may not understand the limited impact of antibiotics on most childhood illnesses.

Doctors face a difficult choice: prescribe an antibiotic and reduce the patient's individual risk of complications, or not prescribe it and thereby reduce the risk to the community—the risk of the emergence of resistant strains of microorganisms. Doctors often choose the former, but the benefits of this choice are unclear. After all, according to research, children who received antibiotics were more likely to return to the doctor within 14 days of prescription than those who did not.

* van Hecke O, Fuller A, Bankhead C et al. Antibiotic exposure and 'response failure' for subsequent respiratory tract infections: an observational cohort study of UK preschool children in primary care // British Journal of General Practice, 2019; 69 (686): e638-e646. DOI: https://doi.org/10.3399/bjgp19X705089\