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Antibiotic Use for Inpatient Bronchiolitis: Did National Guidelines Impact Practice at a Pediatric Hospital?
Alison Ashwini Lopez1, Rana Aslanova2, Natalie Bridger2
1Independent scholar, Calgary, Alberta, Canada; and alison.lopez17@gmail.com.
Insights
National guidelines reduced antibiotic use in hospitalized infants with bronchiolitis. While initial prescriptions remained similar, fewer infants were discharged with antibiotics post-guidelines, indicating practice change.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Bronchiolitis is a common respiratory infection in young children.
- Inpatient management practices for bronchiolitis varied among pediatricians.
- National guidelines were published in 2014 to standardize care, recommending against routine antibiotic use.
Purpose of the Study:
- To evaluate antibiotic prescription patterns for inpatient bronchiolitis management.
- To assess changes in supportive investigations before and after national guideline implementation.
Main Methods:
- Single-center retrospective chart review of pediatric inpatients with bronchiolitis (1-24 months).
- Comparison of two cohorts: pre-guidelines (Nov 2011-Oct 2014) and post-guidelines (Nov 2014-Oct 2016).
- Primary outcome: antibiotic prescription; secondary outcomes: chest radiographs, nasopharyngeal swabs, blood cultures.
Main Results:
- Antibiotic initiation rates were similar between cohorts (approx. 44%).
- Antibiotic discontinuation during hospitalization increased significantly in the post-guidelines cohort (10% vs 20%).
- Fewer patients were discharged with antibiotics in the post-guidelines cohort (31% vs 16%).
Conclusions:
- National guidelines contributed to a reduction in overall antibiotic use for hospitalized bronchiolitis patients.
- While initial prescribing didn't change, guideline adherence improved regarding antibiotic discontinuation and discharge practices.
- Further local initiatives are needed to minimize unnecessary antibiotic use in pediatric respiratory infections.
Background And Objectives:
Bronchiolitis is a common lower respiratory tract infection that affects infants and young children. Because of variability in physician practice, inpatient management varies among pediatricians. In 2014, the Canadian Pediatric Society published national guidelines aimed at standardizing the inpatient management of this illness, which included recommending against the need for antibiotics for most patients. The study objective was to evaluate antibiotic prescription and supportive investigations for inpatient management of bronchiolitis before and after the publication of national guidelines.
Methods:
This study was a single-center retrospective chart review of inpatients with bronchiolitis. We included healthy children 1 to 24 months of age who were admitted from November 2011 to October 2016. Those admitted before December 2014 were analyzed in the preguidelines cohort; the remaining, in the postguidelines cohort. The main outcome was antibiotic prescription. The secondary outcome was the frequency of chest radiographs, nasopharyngeal swabs, and blood cultures.
Results:
A total of 131 patients were included in the first cohort; 71, in the second cohort. The rates of antibiotic initiation were almost equal in both cohorts (∼44%; P = .98). More antibiotics were discontinued during hospitalization in the second cohort compared with the first cohort (10% vs 20%; P = .001). Significantly fewer patients were discharged with antibiotics in the second cohort (31% vs 16%; P = .02).
Conclusions:
Our study revealed a reduction in antibiotic use after the release of national guidelines, illustrating that antibiotic prescribing practices can change. However, there is still a pressing need for local initiatives to continue to reduce the unnecessary use of antibiotics within the pediatric setting.
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