284. Antibiotic Usage in the First Year of Life in HIV-Exposed, Uninfected Infants in Malawi: Results From the Breastfeeding, Antiretrovirals and Nutrition (BAN) Study

BACKGROUND: Antibiotic resistance is a serious health hazard driven by overuse. Antibiotic usage in low-income countries is poorly studied. HIV-exposed, uninfected (HEU) infants are a growing population at high risk for infection and resulting antibiotic use. METHODS: We described antibiotic usage among 2,152 HEU infants in the Breastfeeding, Antiretrovirals and Nutrition (BAN) Study in Lilongwe, Malawi, 2004–2010. Factors were tested for associations with antibiotic prescription using a repeated-measures Cox proportional hazards model and included cotrimoxazole preventive therapy (CPT) exposure, malaria season, antiretroviral (ARV) treatment, receipt of maternal nutritional supplement, maternal CD4(+) T-cell count, HIV viral load, maternal age, infant sex and birthweight. RESULTS: Overall, 80% of HEU infants in the BAN study received an antibiotic prescription during follow-up (median length: 336 days). The majority (67%) of the 5,107 antibiotic prescriptions were for respiratory indications. Penicillins (43%) were the most commonly prescribed type of antibiotics, followed by sulfonamides (23%). The median number of prescriptions received per infant-month was 0.2 (interquartile range (IQR): 0.1, 0.3). Factors associated with lower hazard of antibiotic prescription included CPT exposure (hazard ratio (HR): 0.57 [95% confidence interval (CI): 0.52, 0.61]), maternal ARV (HR: 0.85, 95% CI: [0.78, 0.93]), and infant ARV (HR: 0.90, 95% CI: [0.82, 0.98]). Hazard of antibiotic prescription also decreased as participants aged (HR for ages 6–12 months vs. 0–1 month: 0.48, 95% CI: [0.40, 0.58]). Male sex (HR: 1.09, 95% CI: [1.02, 1.17]) and log maternal viral load (copies/mL) (HR: 1.02, 95% CI: 1.003, 1.04) were associated with increased hazard of antibiotic prescription. CONCLUSION: This study provides an estimate of antibiotic use by HEU infants in a low-income country and evidence that CPT may lead to reduced antibiotic use. DISCLOSURES: All authors: No reported disclosures.