Inappropriate antibiotic prescribing for acute bronchiolitis in Colombia: a predictive model
Jefferson Antonio Buendía1, John Edwin Feliciano-Alfonso2,3
1Grupo de Investigación en Farmacología Y Toxicología, Departamento de Farmacología Y Toxicología, Facultad de Medicina, Universidad de Antioquia, 51D #62-29, Medellín, Colombia. jefferson.buendia@gmail.com.
Insights
Inappropriate antibiotic use in pediatric acute bronchiolitis is common in Colombia. Factors like age over 1 year, chest retractions, and specific fever/leukocyte counts predict this overuse, highlighting the need for careful evaluation.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Epidemiology
- Health Services Research
Background:
- Acute bronchiolitis is a primary cause of pediatric hospitalization.
- Inappropriate antibiotic use in bronchiolitis contributes to antibiotic resistance, increased costs, and adverse events.
- Developing predictive models can optimize antibiotic prescribing in this vulnerable population.
Purpose of the Study:
- To develop and validate a predictive model for inappropriate antibiotic use in children diagnosed with acute bronchiolitis in Colombia.
- To identify clinical and demographic factors associated with unnecessary antibiotic prescriptions.
Main Methods:
- Retrospective cohort study of 415 pediatric patients (<2 years) with acute bronchiolitis in two Colombian hospitals.
- Logistic regression analysis was employed to identify predictors of inappropriate antibiotic use.
- Model discrimination was assessed using Area Under the Curve (AUC) with ROC plots and validated via tenfold cross-validation.
Main Results:
- Antibiotics were prescribed to 34.13% of patients during hospitalization.
- Inappropriate antibiotic prescriptions were identified in 64.78% of those receiving antibiotics.
- Predictive factors for inappropriate use included: age >1 year, chest retractions, temperature 37.5-38.5°C, and leukocyte count 10,000-15,000/mm³.
Conclusions:
- Physicians should be alerted to the high risk of inappropriate antibiotic prescription in acute bronchiolitis patients presenting with fever (37.5-38.5°C), leukocytosis (10,000-15,000/mm³), age over 1 year, and chest retractions.
- A scoring system based on these factors can help identify patients requiring careful evaluation for antibiotic necessity.
- Implementing such predictive tools can guide judicious antibiotic use, mitigating risks associated with overuse in pediatric acute bronchiolitis.
Introduction:
Acute bronchiolitis is the leading cause of hospitalization in the pediatric population. The inappropriate prescription of antibiotics in acute bronchiolitis is associated with bacterial resistance, higher costs, and risk of adverse effects in this population. The objective of this work is to develop a predictive model of inappropriate use of antibiotics in children with acute bronchiolitis in Colombia.
Methods:
A retrospective cohort study was conducted in patients under 2 years of age with a diagnosis of acute bronchiolitis from two hospitals in Rionegro, Colombia. To identify factors independently associated with inappropriate use of antibiotics, we used logistic regression and estimated odds ratios (ORs). To assess discrimination, area under the curve (AUC) was estimated with a 95% confidence interval and plotted using AUC-ROC plots. To correct sampling bias of variance parameters and to evaluate the internal validity of the model, repeated curved validation "tenfold cross-validation" was used, comparing the area under the ROC curve obtained in the repetitions with that observed in the model RESULTS: A total of 415 patients were included. 142 patients (34.13%) had a prescription of some antibiotic during their hospital stay. In 92 patients (64.78%, 95% CI 56.3 to 72.6%) the prescription of antibiotics was classified as inappropriate. Age older than 1 year, chest retractions, temperature between 37.5 °C and 38.5 °C and leukocyte count between 10,000 and 15,000 million/mm3 were the predictive variables of inappropriate use of medications in this population.
Conclusion:
The presence of fever between 37.5 °C and 38.5 °C, leukocytosis between 10,000 and 15,000 million/mm3, and age older than 1 year and presence of chest retractions, should alert the physician regarding the high risk of inappropriate prescription of antibiotics. Patients with acute bronchiolitis with a score on our scale greater than 2 should be carefully evaluated regarding the need for the use of antibiotics, if prescribed.
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