Related Experiment Video
Updated: Dec 21, 2025
Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
Unnecessary antibiotic prescribing in children hospitalised for asthma exacerbation: a retrospective national cohort
Marcella J Jewell1, JoAnna Leyenaar2, Meng-Shiou Shieh3
1Institute of Healthcare Delivery and Population Science, Baystate Medical Center, Springfield, Massachusetts, USA marcella.jewell@baystatehealth.org.
Insights
Antibiotic resistance is a global health threat. In 14% of pediatric asthma hospitalizations, antibiotics were unnecessarily prescribed, highlighting an opportunity for antimicrobial stewardship.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Antibiotic resistance is a significant global public health concern.
- Characterizing antibiotic prescribing for non-infectious conditions like asthma is crucial for antimicrobial stewardship.
- Asthma exacerbations are a common cause of pediatric hospitalizations in the USA.
Purpose of the Study:
- To determine the rate of antibiotic prescribing in children hospitalized for asthma exacerbations.
- To identify patient and hospital factors associated with unnecessary antibiotic use in pediatric asthma hospitalizations.
Main Methods:
- Retrospective analysis of 23,129 pediatric asthma hospitalizations (ages 2-17) from October 2015 to June 2018.
- Exclusion of cases where antibiotic use was justified.
- Hierarchical logistic regression used to identify factors associated with antibiotic treatment.
Main Results:
- Antibiotics were prescribed without clear indication in 14% (3,329) of eligible hospitalizations.
- Prescribing rates varied widely across hospitals (0%-95%).
- Factors associated with antibiotic receipt included complex chronic conditions, ICU admission, and hospitalization at general hospitals with limited pediatric support.
Conclusions:
- Significant opportunity exists to reduce unnecessary antibiotic exposure in pediatric asthma hospitalizations.
- Interventions targeting general hospitals, where most US children receive care, are particularly important.
Background:
Antibiotic resistance represents a worldwide public health threat. Characterising prescribing patterns for conditions for which antibiotics have no role can inform antimicrobial stewardship efforts. Asthma is among the most common non-infectious diseases in children and results in 100 000 hospitalisations annually in the USA. We sought to identify the rate of antibiotic prescribing in children hospitalised for asthma exacerbations, and to characterise patient and hospital factors associated with receipt of antibiotics.
Methods:
Children and adolescents aged 2-17 years admitted to hospital between 1 October 2015 and 30 June 2018 with an asthma exacerbation were identified from the Premier Alliance Database. After excluding hospitalisations for which antibiotics appeared to have been justified, we assessed receipt and duration of antibiotic treatments during the hospital stay. We developed a hierarchical logistic regression model to identify patient and hospital factors associated with antibiotic treatment. For each hospital with at least 10 asthma cases we computed the percentage of cases receiving antibiotic treatment.
Results:
23 129 hospital stays met inclusion criteria; in 3329 (14%) of these, antibiotics were prescribed without clear indication. Hospital prescribing rates varied widely (range 0%-95%), with 25% of hospitals prescribing antibiotics at a rate of 27.5% or more. Patient factors most strongly associated with receipt of antibiotics included the presence of a complex chronic condition (OR: 2.4, 95% CI 2.1 to 2.9; p<0.0001) and admission to the intensive care unit compared with a general medical-surgical bed (OR: 1.6, 95% CI 1.5 to 1.9; p<0.0001). Hospitalisation at general hospitals with minimum paediatric specialty support conferred a nearly threefold higher odds of antibiotic treatment (OR: 2.9, 95% CI 1.5 to 5.6; p<0.0001).
Conclusions:
These findings illustrate an opportunity to reduce unnecessary exposure to antibiotics in children hospitalised with asthma, particularly in general hospitals where three-quarters of children in the USA receive their hospital-based care.
More Related Videos
14:39Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
09:17A Robust Pneumonia Model in Immunocompetent Rodents to Evaluate Antibacterial Efficacy against S. pneumoniae, H. influenzae, K. pneumoniae, P. aeruginosa or A. baumannii
Published on: January 2, 2017
Related Concept Videos
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
01:17Drugs Used in Lower Respiratory Disorders: Overview
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:30Asthma-IV: Nursing Management
First, in...
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...