Prevalence and predictors of residual antibiotics in children's blood in community settings in Tanzania

Theopista Lotto; Sabine Renggli; Eliangiringa Kaale; Honorati Masanja; Beatrice Ternon; Laurent Arthur Décosterd; Valérie D'Acremont; Blaise Genton; Alexandra V Kulinkina

doi:10.1016/j.cmi.2024.05.004

Prevalence and predictors of residual antibiotics in children's blood in community settings in Tanzania

Clin Microbiol Infect. 2024 May 11:S1198-743X(24)00238-6. doi: 10.1016/j.cmi.2024.05.004. Online ahead of print.

Authors

Theopista Lotto¹, Sabine Renggli², Eliangiringa Kaale³, Honorati Masanja⁴, Beatrice Ternon⁵, Laurent Arthur Décosterd⁶, Valérie D'Acremont⁷, Blaise Genton⁸, Alexandra V Kulinkina⁹

Affiliations

¹ Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland; Ifakara Health Institute, Dar es Salaam, Tanzania. Electronic address: theopista.lotto@swisstph.ch.
² Swiss Tropical and Public Health Institute, Allschwil, Switzerland; Ifakara Health Institute, Dar es Salaam, Tanzania.
³ Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
⁴ Ifakara Health Institute, Dar es Salaam, Tanzania.
⁵ Laboratory of Clinical Pharmacology, University Hospital, Lausanne.
⁶ Laboratory of Clinical Pharmacology, University Hospital, Lausanne; University of Lausanne, Lausanne, Switzerland.
⁷ Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland; University of Lausanne, Lausanne, Switzerland; Centre for Primary Care and Public Health, Lausanne, Switzerland.
⁸ University of Lausanne, Lausanne, Switzerland; Centre for Primary Care and Public Health, Lausanne, Switzerland.
⁹ Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.

PMID: 38740136
DOI: 10.1016/j.cmi.2024.05.004

Abstract

Objectives: Children account for a significant proportion of antibiotic consumption in low- and middle-income countries, with overuse occurring in formal and informal health sectors. This study assessed the prevalence and predictors of residual antibiotics in the blood of children in the Mbeya and Morogoro regions of Tanzania.

Methods: The cross-sectional community-based survey used two-stage cluster sampling to include children aged under 15 years. For each child, information on recent illness, healthcare-seeking behaviour, and use of antibiotics, as well as a dried blood spot sample, were collected. The samples underwent tandem mass spectrometry analysis to quantify the concentrations of 15 common antibiotics. Associations between survey variables and the presence of residual antibiotics were assessed using mixed-effects logistic regression.

Results: In total, 1742 children were surveyed, and 1699 analysed. The overall prevalence of residual antibiotics in the blood samples was 17.4% (296/1699), the highest among children under the age of 5 years. The most frequently detected antibiotics were trimethoprim (144/1699; 8.5%), sulfamethoxazole (102/1699; 6.0%), metronidazole (61/1699; 3.6%), and amoxicillin (43/1699; 2.5%). The strongest predictors of residual antibiotics in the blood were observed presence of antibiotics at home (adjusted odds ratio [aOR] = 2.9; 95% CI, 2.0-4.1) and reported consumption of antibiotics in the last 2 weeks (aOR = 2.5; 95% CI, 1.6-3.9). However, half (145/296) of the children who had residual antibiotics in their blood, some with multiple antibiotics, had no reported history of illness or antibiotic consumption in the last 2 weeks, and antibiotics were not found at home.

Discussion: This study demonstrated a high prevalence of antibiotic exposure among children in Tanzanian communities, albeit likely underestimated, especially for compounds with short half-lives. A significant proportion of antibiotic exposure was unexplained and may have been due to unreported self-medication or environmental pathways. Incorporating biomonitoring into surveillance strategies can help better understand exposure patterns and design antibiotic stewardship interventions.

Keywords: Antimicrobial resistance (AMR); Community survey; Dried blood spot (DBS); Drug pressure; Residual antibiotics; Tanzania.