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Understanding physician antibiotic prescribing behavior for children with enterovirus infection

Kuang-Che Kuo1, Yi-Chun Yeh2, Ying-Hsien Huang1

  • 1Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Plos One
|September 8, 2018
PubMed

Insights

Pediatricians often prescribe antibiotics for enterovirus infections like HFMD, despite their ineffectiveness. Elevated C-reactive protein (CRP) levels are a key factor influencing this antibiotic prescribing behavior in children.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship
  • Clinical Decision Making

Background:

  • Antibiotics are frequently prescribed for enterovirus infections (e.g., herpangina, hand-foot-mouth disease) despite being ineffective against viruses.
  • Previous studies indicated a lack of clinical justification for antibiotic use in such cases.
  • Improving healthcare quality necessitates understanding factors influencing antibiotic prescribing in pediatric enterovirus infections.

Purpose of the Study:

  • To evaluate the association between clinical and demographic characteristics and antibiotic prescribing in children with enterovirus infections.
  • To identify key determining factors for antibiotic prescription in pediatric herpangina and HFMD cases.

Main Methods:

  • Retrospective review of medical records for children hospitalized with herpangina or HFMD between 2008 and 2016.
  • Identification of children prescribed antibiotics for ≥24 hours during admission.
  • Descriptive analysis to determine factors associated with pediatrician antibiotic prescribing.

Main Results:

  • Approximately 13% of patients received antibiotics during the study period.
  • Elevated C-reactive protein (CRP) and leukocytosis (WBC) were significantly associated with antibiotic prescribing (p<0.001).
  • CRP levels showed a stronger predictive value (AUC=0.708) than WBC for antibiotic prescribing.

Conclusions:

  • Higher serum CRP levels strongly correlate with antibiotic prescribing in children with herpangina or HFMD.
  • Antibiotic prescribing is complex, requiring judicious decision-making by pediatricians.
  • Findings aim to improve understanding of prescribing patterns and reduce inappropriate antibiotic use.
Abstract

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