Antibiotic Prescribing Practices and Health Outcomes: Stunting and Rotavirus Vaccine Seroconversion among NIDI Infants at Hospital Los Andes in El Alto, Bolivia Open Access

Abstract

Antibiotic Prescribing Practices and Health Outcomes: Stunting and Rotavirus Vaccine Seroconversion among NIDI Infants at Hospital Los Andes in El Alto, Bolivia

Background: Antibiotics prescription rates are growing at exponential rates, including in infants. Antibiotic exposure early in life has been hypothesized as a potential factor in both low vaccine response and risk of stunting through the changes in gut microbiota that antibiotic exposure may induce (Mahfuz et al., 2017; Sommer & Backhed, 2013; Velasquez, Parashar, & Jiang, 2017)

Goal: This study aims to explore the potential relationship between physician antibiotic prescribing behavior as a measure of early antibiotic exposure and the health outcomes stunting and rotavirus vaccine seroconversion among infants 6 months of age at Hospital Los Andes in El Alto, Bolivia.

Methods: In 2013, Bolivian and US collaborators conducted a longitudinal comprehensive study-- Nutrición, Inmunología, y Diarrea Infantil (NIDI) at two Bolivian hospitals. In 2017, medical records of 135 infants at six months previously enrolled in the NIDI study at Hospital Los Andes were examined to collect additional data on with antibiotic prescription as a measure of exposure. To statistically analyze the potential relationships, logistic regression and chi-square analysis was completed with data retrieved from both the NIDI study and medical records of infants at Hospital Los Andes. The health outcomes, stunting and Rotavirus vaccine seroconversion data were extracted from the prior NIDI database.

Results: Of the patient records analyzed, 24% of infants were prescribed antibiotics by 6 months of age. There was a significant association observed between having been prescribed antibiotics at or before 6 months of age and stunting (odds ratio: 2.4, 95% confidence interval: 1.05–5.48, P= 0.04). There was no significant relationship observed between having had antibiotics prescribed and Rotavirus vaccine seroconversion at 6 months of age (odds ratio = 0.68, 95% confidence interval: 0.29–1.57, P=0.36).

Discussion and Conclusion: The effect of antibiotic exposure on developing infants from birth to 6 months of age are still unknown. One potential mechanism may include the imbalance of gut microbiota, which may impact immune responses and increase the incidence of diarrhea causing nutritional deficiencies, such as stunting. The results of this analysis suggest a continued need to investigate the effects of early-life antibiotic exposure, as antibiotics in infants 6 months of age is associated with an increased prevalence of stunting.

Table of Contents

TABLE OF CONTENTS INTRODUCTION………………………………………………………………….….….…….1 LITERATURE REVIEW……………………………………………………………..….……..4 METHODS…………………………………………………………………..………..…….…..17 RESULTS……………………………………………………………………….….……….…..21 DISCUSSION……………………………………………………………..……....…………....31 PUBLIC HEALTH IMPLICATIONS…………………………………………………………..37 CONCLUSION……………………………………………………………………..…………...40 REFERENCES………………………………………………………………………………….41 APPENDIX 1: CHART ABSTRACTION TOOL ……………………………………………..45 APPENDIX 2: CONCEPTUAL FRAMEWORK: STUNTING…………………......................46 APPENDIX 3: CONCEPTUAL FRAMEWORK: SEROCONVERSION……………………..46 APPENDIX 4: CONFOUNDING MODEL…………………...…………………......................47 APPENDIX 5: DATA CRITERION METHOD: STUNTING………..………………………..47 APPENDIX 6: DATA CRITERION METHOD: SEROCONVERSION……..………………..47

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	public health Bolivia pediatric seroconversion gut microbiota antibiotic exposure infant Maternal and child health vaccine gut microbiome stunting antibiotics Rotavirus
Committee Chair / Thesis Advisor	Leon, Juan, Emory University
Committee Members	Prince-Guerra, Jessica, Emory University Rebolledo, Paulina, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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