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Antibiotic Use in Paediatric Patients Hospitalized with Acute Severe Asthma
Jordis Trischler1, Malin von Blumroeder1, Helena Donath1
1Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany.
Insights
Antibiotic use for pediatric asthma exacerbations is common, especially in younger children, even without clear bacterial infection. Clinical signs of severe illness often lead to antibiotic prescription in these cases.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Clinical Decision-Making
Background:
- Antibiotic use is frequent in pediatric asthma exacerbations, despite not being routinely recommended.
- This practice occurs in both outpatient and inpatient settings.
Purpose of the Study:
- To analyze the frequency and patterns of antibiotic use during acute severe asthma exacerbations in children.
- To investigate the clinical decision-making processes behind antibiotic prescriptions.
Main Methods:
- Retrospective analysis of 580 inpatient admissions for acute severe asthma over 10 years at a German Children's University hospital.
- Inclusion of patient data: age, length of stay, oxygen use, treatments, lab results, and chest X-rays.
Main Results:
- Overall antibiotic use was high, decreasing with age (69.6% in 1-5 years to 39.7% in 12-17 years).
- Antibiotic treatment without clear indication was 28.3%, with macrolides being most common.
- Factors increasing antibiotic use without clear indication included younger age, elevated C-reactive protein, oxygen supplementation, and fever.
Conclusions:
- Antibiotic treatment without clear indication is prevalent in pediatric severe asthma exacerbations.
- Clinical indicators of disease severity influence antibiotic prescription decisions, even without confirmed bacterial infection or proven benefit.
Background:
Antibiotic use during asthma exacerbations in paediatric patients is not routinely recommended but common practise in out-patient and in-patient settings. Objective of this study was to analyse frequency of antibiotic use during acute severe asthma exacerbations, antibiotic classes utilized and clinical decision-making.
Methods:
All in-patient admissions over 10 years in a single German Children's University hospital due to acute severe asthma were included in this retrospective analysis. Age, length of stay, oxygen supplementation, treatment, laboratory parameters and chest x-rays of all patients ranging from 1 to 17 years were analysed.
Results:
580 hospital admissions were included in this study. Overall antibiotic use was high but decreased with age (1-5 years 69,6%, 6-11 years 57,6% and 12-17 years 39,7%, p<0.001). Analysis of antibiotic treatment without clear indication showed a consistently lower treatment rate of 28.3%, with macrolides being the most common antibiotic class. Younger age significantly decreased, whereas, increase of CrP value, use of oxygen supplementation and concomitant fever all significantly increased the odds ratio (OR 0.967; 4.366, 2.472 and 2.011 respectively) of receiving antibiotic treatment without clear indication.
Conclusion:
Antibiotic treatment without clear indication during acute severe asthma is common in this German single-centre cohort. Clinical parameters of more severe disease affect clinician's decision to administer antibiotics despite evidence of bacterial infection or improved outcome.
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