Among 33,000 preschool children in the UK (who received at least one prescription of amoxicillin) there were ~15% fewer amoxicillin prescriptions given during the influenza season to children who had received the live attenuated influenza vaccine than among children who were not vaccinated. This suggests that flu vaccination may lead to a reduction in excess, inappropriate prescribing of antibiotics for influenza in children.
Antibiotic Resistance
Immunization reduces antibiotic use in children by preventing flu-related illnesses and secondary infections
Several studies have shown a 13-50% reduction in the use of antibiotics by children who have received influenza vaccine compared with unvaccinated controls. This is due to a decline in febrile illnesses causes by influenza — for which antibiotics are often prescribed inappropriately — as well as a decline in secondary bacterial infections requiring antibiotic treatment, such as pneumonia and middle ear infections, that are triggered by influenza.
Immunization with pneumococcal conjugate vaccine reduces drug-resistant cases of pneumococcal diseases in children and adults
Studies in several countries have shown that, following the introduction of pneumococcal conjugate vaccine, there was a reduction in the number and percent of drug-resistant cases of pneumococcal diseases in children, and in some countries in adults, due to herd effects. In Japan there was a 10-fold decline in the proportion of penicillin-resistance among cases of invasive pneumococcal disease (from 56% to 5%), and in the U.S. there were reductions of 81% and 49% in the proportion of penicillin-resistant cases in children less than two years and in adults more than 65 years old, respectively.
Immunization with PCV reduced antibiotic prescriptions for children and slowed antibiotic resistance
In Iceland, a study of all children born over an 11-year period, before and after the introduction of pneumococcal conjugate vaccine (PCV) into the national immunization program, found a 6% decrease in all antibiotic prescriptions for children during their first four years of life and a 22% reduction in prescriptions for otitis media after the vaccine was introduced. Thus, in addition to reducing the burden of pneumococcal disease, PCV may also slow the spread of antibiotic resistance.
Immunizing infants against typhoid can sharply reduce antibiotic-resistant cases
A study of the impact of typhoid conjugate vaccines in a hypothetical endemic population predicts that the number of antibiotic-resistant typhoid cases will decrease sharply if at least 80% of infants are vaccinated. However, the percent of cases that are resistant is not expected to change with vaccination, thus the disease will have to be nearly eliminated to get rid of all antibiotic resistant typhoid.
The pneumococcal conjugate vaccine was associated with a decline in antibiotic-resistant pneumococcal cases in South Africa
This study from South Africa demonstrates significant declines in invasive pneumococcal disease cases caused by bacteria that are resistant to one or more antibiotics. In fact, the rate of infections resistant to two different antibiotics declined nearly twice as much as infections that could be treated with antibiotics.
Antibiotic resistance in pneumococcal infections is common among Indian children
A systematic review of studies from India found that prior to widespread use of the pneumococcal conjugate vaccine, antibiotic resistance in serious pneumoccocal infections among Indian children has been common. Penicillin resistance was found in 10% of invasive pneumococcal disease (IPD) cases, while trimethoprim/sulfamethoxazole resistance was found in more than 80% of these cases.
Large study in California finds significant reduction in need for antibiotics in vaccinated children
In a study evaluating the impact of PCV7 on 40,000 recipients and control subjects in northern California revealed that the vaccine could significantly decrease the need for antibiotics to treat the disease. The children who had received the vaccine displayed a 5.4% reduction in the number of antibiotic prescriptions and a 12.6% reduction in the use of “second-line antibiotics” compared to the controls. Additionally, when looking at children in the time period between their first dose and attainment of the age of 3.5 years, receiving the vaccine had prevented 35 antibiotic prescriptions per 100 fully vaccinated children.
PCV vaccination at day-care centers reduced antibiotic use in children
Evaluation of the ability of pneumococcal conjugate vaccine to reduce the occurrence of respiratory infections and the resultant antibiotic drug use was conducted among day care attendees in Israel. It was observed that children who had received the 9-valent conjugate vaccine showed a 17% overall reduction in antibiotic usage. In particular, a 10% reduction in days of antibiotic usage for upper respiratory tract infections, 47% fewer days of antibiotic usage for lower respiratory tract infections, and 20% fewer days of antibiotic usage for otitis media (ear infections) when compared to children who did not receive PCV.
PCV introduction may indirectly protect HIV-infected parents from antibiotic resistant microorganisms
Among both HIV positive and HIV negative parents in a study in Kenya, 99% of pneumococcal strains found and tested were resistant to one or more antibiotics. HIV positive parents carried 16% more strains that were resistant to penicillin than those carried by HIV negative parents.