Dataset Information

Antibiotic-Induced Liver Injury in Paediatric Outpatients: A Case-Control Study in Primary Care Databases.

ABSTRACT:

Introduction

Antibiotics are the most commonly prescribed drug class in children. Real-world data mining on the paediatric population showed potential associations between antibiotic use and acute liver injury.

Objective

We assessed risk estimates of liver injury associated with antibiotic use in children and adolescent outpatients.

Methods

A large, multi-database, population-based, case-control study was performed in people <18 years of age from two European countries (Italy and The Netherlands) during the period 2000-2008. All potential cases of liver injury were automatically extracted from three databases and then manually validated based on Council for International Organizations of Medical Sciences (CIOMS) criteria and by exclusion of all competing causes for liver injury. Up to 100 control participants were sampled for each case and were matched on index date of the event, age, sex and database. Based on prescription data, antibiotic exposure was categorized as current, recent or past use by calculating the time period between the end of prescription and the index date. Multivariate conditional logistic regression analyses were applied to calculate odds ratios (ORs) as a measure of the association (with 95% confidence interval [CI]).

Results

We identified 938 cases of liver injury and matched to 93,665 controls. Current use of overall antibiotics is associated with a threefold increased risk of liver injury compared with past use (adjusted OR [OR_adj] 3.22, 95% CI 2.57-4.03). With regard to individual antibiotics, the risk is significantly increased for current use of each antibiotic (p < 0.005), except for azithromycin. Risk estimates vary from the lowest OR_adj of 1.86 (95% CI 1.08-3.21) for amoxicillin to the highest OR_adj of 24.16 (95% CI 11.78-49.54) for cotrimoxazole (i.e. sulphamethoxazole/trimethoprim) and 26.70 (95% CI 12.09-58.96) for ceftriaxone. Sensitivity analyses confirm the associations for ceftriaxone, cotrimoxazole, and clarithromycin.

Conclusion

Antibiotic-induced liver injury in children is heterogeneous across the use of individual antibiotics. When prescribing ceftriaxone, cotrimoxazole and clarithromycin in children, paediatricians should definitely be aware of their potential risk of liver injury, even if for short periods.

SUBMITTER: Ferrajolo C

PROVIDER: S-EPMC5362651 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Publications

Antibiotic-Induced Liver Injury in Paediatric Outpatients: A Case-Control Study in Primary Care Databases.

Ferrajolo Carmen C Verhamme Katia M C KM Trifirò Gianluca G 't Jong Geert W GW Picelli Gino G Giaquinto Carlo C Mazzaglia Giampiero G Stricker Bruno H BH Rossi Francesco F Capuano Annalisa A Sturkenboom Miriam C J M MC

Drug safety 20170401 4

<h4>Introduction</h4>Antibiotics are the most commonly prescribed drug class in children. Real-world data mining on the paediatric population showed potential associations between antibiotic use and acute liver injury.<h4>Objective</h4>We assessed risk estimates of liver injury associated with antibiotic use in children and adolescent outpatients.<h4>Methods</h4>A large, multi-database, population-based, case-control study was performed in people <18 years of age from two European countries (Ita ...[more]

PMID: 28025733

Similar Datasets

Project description:There is growing attention for antimicrobial stewardship in paediatrics. Currently, little is known about secondary care antibiotic practice. We analysed trends in time with respect to inpatient antibiotic use in a secondary paediatric care setting. Total inpatient antibiotic consumption per year (2010-2015) and antibiotic prescriptions for urinary tract infection (UTI) and lower respiratory tract infection (LRTI) were analysed. Variables were total, antibiotic-specific, and intravenous days of therapy (DOT/100PD) and for UTI/LRTI treatment type, route and duration. Third-generation cephalosporin use decreased (DOT/100PD 11.6 in 2011 vs. 5.1 in 2015; p?<?0.001); intravenous antibiotics were prescribed less often (p?=?0.06). These findings were confirmed for the specific diseases: third-generation cephalosporin use decreased for both UTI (93% vs. 45%; p?=?0.002) and LRTI (14% vs. 6%; p?=?0.18); the duration of intravenous therapy decreased (UTI p?=?0.02; LRTI p?<?0.001). Median LRTI treatment duration was 9.2 days in 2008 and 6.6 in 2015 (p?<?0.001); penicillin prescriptions were more narrow in spectrum (p?=?0.02).ConclusionA decrease in third-generation cephalosporin use and intravenous route was identified. LRTI treatment was significantly shorter and more narrow in spectrum. This could be explained by awareness and interventions in the context of antimicrobial stewardship. A decrease in antibiotic use is also feasible and important in non-tertiary paediatric wards. What is Known: • Antimicrobial stewardship programmes are effective in reduction of total and broad-spectrum antibiotic use in tertiary paediatric hospitals • The majority of hospitalised paediatric patients are admitted at general, secondary care wards, often for infectious diseases What is New: • Antimicrobial stewardship interventions in secondary care are also effective in establishing a reduction in broad-spectrum antibiotic use, intravenous route and days on antibiotic therapy.

Dataset Information

Antibiotic-Induced Liver Injury in Paediatric Outpatients: A Case-Control Study in Primary Care Databases.

Introduction

Objective

Methods

Results

Conclusion

Publications

Antibiotic-Induced Liver Injury in Paediatric Outpatients: A Case-Control Study in Primary Care Databases.

Similar Datasets

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