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Antibiotic Overuse in Children with Respiratory Syncytial Virus Lower Respiratory Tract Infection
Chantal B van Houten1, Christiana Naaktgeboren2, Brigitte J M Buiteman1
1From the Department of Pediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands.
Insights
Respiratory syncytial virus (RSV) infections in infants often lead to unnecessary antibiotic use. This study found that nearly one-third of children with RSV lower respiratory tract infections were treated with antibiotics without a bacterial coinfection diagnosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTI) in infants.
- Bacterial coinfection is a concern in RSV cases, necessitating antibiotic treatment.
- Overuse of antibiotics in viral infections is a significant public health issue.
Purpose of the Study:
- To determine the incidence of bacterial coinfections in children with RSV LRTI.
- To quantify antibiotic overuse in children diagnosed with RSV infection.
- To utilize an expert panel for accurate diagnosis of bacterial coinfection in RSV cases.
Main Methods:
- Prospective international multicenter study involving children aged 1 month and older with LRTI or fever.
- RSV infection confirmed via Polymerase Chain Reaction (PCR) on nasal swabs.
- Expert panel of pediatricians diagnosed bacterial coinfection using clinical data and follow-up.
Main Results:
- Out of 784 recruited patients, 188 (24%) had RSV.
- 92 (49%) of RSV-positive children received antibiotics.
- Antibiotics were given to all 27 children with bacterial coinfection, but also to 57 (62%) without bacterial coinfection.
Conclusions:
- This study is the first prospective international multicenter RSV study using an expert panel to differentiate bacterial coinfection.
- All identified bacterial coinfections were appropriately treated with antibiotics.
- Approximately one-third of children with RSV LRTI received unnecessary antibiotic treatment.
Background:
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections (LRTI) during the first year of life. Antibiotic treatment is recommended in cases suspected of bacterial coinfection. The aim of this prospective study was to estimate the incidence of bacterial coinfections and the amount of antibiotic overuse in children infected with RSV using expert panel diagnosis.
Methods:
Children 1 month of age and over with LRTI or fever without source were prospectively recruited in hospitals in the Netherlands and Israel. Children with confirmed RSV infection by Polymerase Chain Reaction (PCR) on nasal swabs were evaluated by an expert panel as reference standard diagnosis. Three experienced pediatricians distinguished bacterial coinfection from simple viral infection using all available clinical information, including all microbiologic evaluations and a 28-day follow-up evaluation.
Results:
A total of 188 children (24% of all 784 recruited patients) were positive for RSV. From these, 92 (49%) were treated with antibiotics. All 27 children (29%) with bacterial coinfection were treated with antibiotics. Fifty-seven patients (62%) were treated with antibiotics without a diagnosis of bacterial coinfection. In 8 of the 92 (9%), the expert panel could not distinguish simple viral infection from bacterial coinfection.
Conclusion:
This is the first prospective international multicenter RSV study using an expert panel as reference standard to identify children with and without bacterial coinfection. All cases of bacterial coinfections are treated, whereas as many as one-third of all children with RSV LRTI are treated unnecessarily with antibiotics.
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