title: Reduction in diarrhoeal rates through interventions that prevent unnecessary antibiotic exposure early in life in an observational birth cohort.
abstract: BACKGROUND
  Antibiotic treatment early in life is often not needed and has been associated with increased rates of subsequent diarrhoea. We estimated the impact of realistic interventions, which would prevent unnecessary antibiotic exposures before 6 months of age, on reducing childhood diarrhoeal rates.
  
  
  METHODS
  In data from a prospective observational cohort study conducted in Vellore, India, we used the parametric g-formula to model diarrhoeal incidence rate differences contrasting the observed incidence of diarrhoea to the incidence expected under hypothetical interventions. The interventions prevented unnecessary antibiotic treatments for non-bloody diarrhoea, vomiting and upper respiratory infections before 6 months of age. We also modelled targeted interventions, in which unnecessary antibiotic use was prevented only among children who had already stopped exclusive breast feeding.
  
  
  RESULTS
  More than half of all antibiotic exposures before 6 months (58.9%) were likely unnecessary. The incidence rate difference associated with removing unnecessary antibiotic use before 6 months of age was -0.28 (95% CI -0.46 to -0.08) episodes per 30 child-months. This implies that preventing unnecessary antibiotic exposures in just 4 children would reduce the incidence of diarrhoea by 1 from 6 months to 3 years of age.
  
  
  CONCLUSIONS
  Interventions to reduce unnecessary antibiotic use among young children could result in an important reduction in diarrhoeal rates. This work provides an example application of statistical methods which can further the aim of presenting epidemiological findings that are relevant to public health practice.
authors.affiliation: Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Elizabeth T
authors.identifier: http://orcid.org/0000-0002-4942-3747
authors.initials: ET
authors.lastname: Rogawski
authors.affiliation: Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
authors.affiliation: Department of Family Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Becker-Dreps
authors.affiliation: Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Adair
authors.affiliation: Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA Department of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sarkar
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Deepthi
authors.initials: D
authors.lastname: Kattula
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA.
authors.forename: Honorine D
authors.initials: HD
authors.lastname: Ward
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Kang
authors.affiliation: Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Westreich
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant
chemical_list: D000900:Anti-Bacterial Agents
keywords: CHILD HEALTH; DIARRHOEA; DRUG MISUSE; Epidemiological methods; PUBLIC HEALTH