{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T17:31:08Z","timestamp":1774459868418,"version":"3.50.1"},"reference-count":41,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2015,11,9]]},"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Antibiotic treatment early in life is often not needed and has been associated with increased rates of subsequent diarrhoea. We estimated the impact of realistic interventions, which would prevent unnecessary antibiotic exposures before 6\u2005months of age, on reducing childhood diarrhoeal rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In data from a prospective observational cohort study conducted in Vellore, India, we used the parametric g-formula to model diarrhoeal incidence rate differences contrasting the observed incidence of diarrhoea to the incidence expected under hypothetical interventions. The interventions prevented unnecessary antibiotic treatments for non-bloody diarrhoea, vomiting and upper respiratory infections before 6\u2005months of age. We also modelled targeted interventions, in which unnecessary antibiotic use was prevented only among children who had already stopped exclusive breast feeding.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>More than half of all antibiotic exposures before 6\u2005months (58.9%) were likely unnecessary. The incidence rate difference associated with removing unnecessary antibiotic use before 6\u2005months of age was \u22120.28 (95% CI \u22120.46 to \u22120.08) episodes per 30 child-months. This implies that preventing unnecessary antibiotic exposures in just 4 children would reduce the incidence of diarrhoea by 1 from 6\u2005months to 3\u2005years of age.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Interventions to reduce unnecessary antibiotic use among young children could result in an important reduction in diarrhoeal rates. This work provides an example application of statistical methods which can further the aim of presenting epidemiological findings that are relevant to public health practice.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2015-206635","type":"journal-article","created":{"date-parts":[[2015,11,30]],"date-time":"2015-11-30T23:05:03Z","timestamp":1448924703000},"page":"500-505","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Reduction in diarrhoeal rates through interventions that prevent unnecessary antibiotic exposure early in life in an observational birth cohort"],"prefix":"10.1136","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4942-3747","authenticated-orcid":false,"given":"Elizabeth T","family":"Rogawski","sequence":"first","affiliation":[{"name":"Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven R","family":"Meshnick","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvia","family":"Becker-Dreps","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda S","family":"Adair","sequence":"additional","affiliation":[{"name":"Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert S","family":"Sandler","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA"},{"name":"Department of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajiv","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepthi","family":"Kattula","sequence":"additional","affiliation":[{"name":"Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Honorine D","family":"Ward","sequence":"additional","affiliation":[{"name":"Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India"},{"name":"Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gagandeep","family":"Kang","sequence":"additional","affiliation":[{"name":"Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J","family":"Westreich","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,11,30]]},"reference":[{"key":"2025100300135137000_70.5.500.1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3260"},{"key":"2025100300135137000_70.5.500.2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-2903"},{"key":"2025100300135137000_70.5.500.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.23.3096"},{"key":"2025100300135137000_70.5.500.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15495-0"},{"key":"2025100300135137000_70.5.500.5","doi-asserted-by":"crossref","unstructured":"Glasziou PP , Del Mar CB , Sanders SL , et al . 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