Analysis of antibiotic use and misuse in children hospitalized with RSV infection

To determine the extent of, rationale for and acquisition cost of antibiotic use in a cohort of children with lower respiratory tract infection (LRI) secondary to the respiratory syncytial virus (RSV).

Prospective, observational cohort study.

Patients younger than two years of age admitted to a tertiary care paediatric hospital with a clinical diagnosis of LRI and positive direct immunoflourescence microscopy and/or viral culture for RSV were eligible. Patients older than two years with underlying cardiac abnormalities, respiratory disease or immunosuppression were also eligible. Patients were enrolled as part of the Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of RSV-related LRI.

One hundred and fifty-two patients were enrolled between January 1 and April 30, 1993. Median age was 5.6 months (range 0.2 to 151 months); the male to female ratio was 1.6:1. Morbidity was comparable with that of previously reported cohorts, and no patients died. Sixty-seven (44%) patients received an antibiotic before hospitalization, and ninety-two (60.5%) received at least one antibiotic during hospitalization. Of those receiving antibiotics in hospital, 65 were given oral and 44 intravenous preparations. Reasons for antibiotic prescription during hospitalization were otitis media (37%), 'pneumonia' (31%) and suspected sepsis (9%). Twenty-three per cent had no documented reason. In patients started on intravenous antibiotics, only 32% (14) had the medication discontinued once RSV infection was confirmed. Of the remaining 30 patients, 10 had positive blood (16.6%) or urine (16.6%) cultures, and 15 (50%) had no clearly defined bacterial etiology or rationale documented. Eighty-eight per cent of patients who received ribavirin also received an antibiotic compared with 55% of patients who did not receive ribavirin (P<0.005). The total medication cost of the administered antibiotics was CDN$4,578.16. Eleven adverse events were recorded in children given antibiotics, of which 10 (91%) were in those receiving intravenous preparations.

This study demonstrated that a high percentage of children admitted to hospital with LRI secondary to RSV received antibiotics in the absence of a clearly defined bacterial coinfection. Physician education strategies should stress discontinuation of antibiotic therapy once RSV infection is diagnosed. This may diminish the development of resistant bacteria, reduce health care costs and minimize the potential for adverse events associated with inappropriate antibiotic use.