21 The association between early life exposure to antibiotics and antibiotics for upper respiratory tract infections in later childhood
Bibliographic record
Abstract
Clinical guidelines recommend avoidance of antibiotics for uncomplicated upper respiratory tract infections (URTIs) in children with the exception of acute otitis media (AOM) under two years of age. Prescription of antibiotics for URTIs in early life may set expectations for antibiotics for subsequent URTIs. The primary objective of this study was to evaluate whether early life (< 2 years of age) antibiotic prescription for URTIs at a sick visit was associated with antibiotic prescription for URTI at a sick visit in later childhood (>2 years of age). The secondary objective was to investigate whether this relationship was different for antibiotics prescribed for AOM in early life. A prospective cohort study was conducted through a large primary care practice-based research network. Generalized Estimating Equation (GEE) modeling was used to investigate the association between (i) early life (< 2 years of age) antibiotic prescription for URTIs and antibiotic prescription for URTI later in childhood (> 2 years of age); and (ii) early life exposure to antibiotic prescription for AOM vs. non-AOM URTIs and antibiotic receipt for URTIs later in childhood. 2380 children were included in the study, of which 653 (27%) had received an antibiotic for URTI before two years of age. Children who received an antibiotic for URTI under 2 years of age had higher odds of receiving antibiotics for URTI after two years of age (adjusted OR per visit: 1.40; 95% CI: 1.20, 1.64; p<0.001). Children who received an antibiotic for AOM under 2 years of age also had higher odds of receiving antibiotics for URTI after two years of age (adjusted OR per visit: 1.46; 95% CI: 1.23, 1.74; p<0.001). No statistically significant association was found between exposure to antibiotics prescription for non-AOM URTI under 2 years of age and antibiotics for URTI per visit after 2 years of age (p=0.24). Early life antibiotic prescription for URTI, including AOM, may increase the risk of antibiotic prescription for subsequent URTIs. While the reasons for this association are likely multifactorial, setting expectations for antibiotics for URTI in early life may play a role. Avoidance of antibiotic prescribing for URTIs in early life may help curtail antibiotic use for URTIs in later childhood. Future research is needed to minimize antibiotic prescription when it might not be necessary, particularly early in life.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".