Respiratory Tract Infections in Children with Down's Syndrome

BACKGROUND: Children with Down’s Syndrome (DS) are prone to respiratory tract infections (RTIs), yet there is little evidence to guide clinical practice. AIMS: For children with and without DS, this thesis aims to use routinely collected data to identify RTI-related healthcare utilisation, those most at risk of RTI-related healthcare utilisation, and the effects of antibiotics in preventing RTI-related hospitalisation. METHODS: A systematic review of existing interventions and a retrospective cohort study based on routinely collected primary and secondary care data (CALIBER). KEY FINDINGS: The CALIBER cohort comprised 992 children with DS and 4874 controls. Children with DS consulted their GP for RTIs twice as often as controls, were prescribed antibiotics twice as often, and were hospitalized six times as often. In children with DS, younger age, congenital heart disease and asthma were risk factors for RTI-related healthcare utilisation. Using multivariate analysis, this study found that for infants with DS, the prescription of antibiotics significantly reduced subsequent RTI-related hospitalisation - the number needed to treat is 11.9. Separate analysis, inverse probability of treatment weighting, found that the protective effect for infants with DS was not significant. When prescriptions were analysed by type of RTI, the prescription of antibiotics for upper RTIs did not reduce the risk of hospitalization for children with DS or controls. This was also the case for lower RTIs, although with a small sample. CONCLUSION: For children with DS over the age of one presenting with RTIs to primary care, antibiotic treatment does not prevent subsequent RTI-related hospitalisation. There is conflicting evidence from two separate analysis methods as to whether treating infants with DS with antibiotics prevents RTI-related hospitalisation, so further research is recommended. Further prescribing strategies (i.e. rescue antibiotics) should be explored to broaden the evidence base for this at-risk group