Assessing the use of antibiotics in pediatric patients hospitalized for varicella
Elena Bozzola1, Silvio Marchesani2, Andrea Ficari2
1Pediatric Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy. elena.bozzola@opbg.net.
Insights
Antibiotic use in hospitalized pediatric varicella patients significantly increases costs and hospitalization length. Optimizing antibiotic prescriptions and increasing immunization are key to reducing costs and antimicrobial resistance.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Pharmacy and Economics
- Antimicrobial Stewardship
Background:
- Varicella (chickenpox) can lead to severe complications requiring hospitalization.
- Antibiotics are not primary treatment but used for complications or prophylaxis.
- Understanding antibiotic patterns and costs in varicella hospitalizations is crucial.
Purpose of the Study:
- To analyze antibiotic use rates and patterns in pediatric varicella hospitalizations.
- To determine the associated economic costs of antibiotic therapy.
- To provide insights for optimizing antibiotic stewardship in varicella cases.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) hospitalized for varicella.
- Data collected from electronic medical records at Bambino Gesù Children's IRCCS Hospital, Rome.
- Evaluation of antibiotic prescription rates, patterns, costs, and hospitalization length.
Main Results:
- 42.6% of 810 pediatric varicella patients received antibiotics, primarily for complications (90%).
- Antibiotic therapy significantly increased hospitalization costs (5.9% of total) and length of stay.
- Amoxicillin-clavulanate and Ceftriaxone were the most common antibiotics prescribed.
Conclusions:
- Inappropriate antibiotic use in varicella contributes to increased healthcare costs and antimicrobial resistance.
- Strategies for reducing costs and resistance include appropriate antibiotic prescription and enhanced immunization.
- Optimizing antibiotic stewardship and disease prevention are vital for public health.
Background:
Varicella is considered a mild and self-limiting disease, but, in some cases, it may complicate and require hospitalization. Antibiotics are not the first line therapy but in some cases are prescribed either for the management of varicella-related complications or as a preventive strategy. Aim of this study is to analyze the rate and the patterns of antibiotics used in pediatric patients hospitalized for varicella as well as the relative costs in order to increase insights in antibiotic use in varicella.
Methods:
Patients less than 18 years hospitalized for varicella at the Bambino Gesù Children's IRCCS Hospital in Rome, Italy, from the 1st of November 2005 to the 1st of November 2021 entered the study. Retrospective data were collected from the hospital's database electronic medical records. The rate, the patterns and the costs of antibiotics used were considered.
Results:
According to the inclusion criteria, we enrolled 810 patients, with a median age of 2.4 years. Out of them, 345 patients (42.6%) underwent antibiotic therapy, of which 307 for a complication (90.0%) and the other 10.0%, antibiotic for the fear of developing complications. The cost for varicella hospitalizations was EUR 2,928,749 (median cost EUR 2689). As for antibiotic therapy, it represented the 5.9% of the total cost (EUR 174,527), with a median cost of EUR 198.8. The cost in patients who underwent antibiotic therapy was significantly higher than in those who did not (p-value < 0.0001), as well as the hospitalization length (p-value < 0.0001). The most commonly prescribed antibiotics were Amoxicillin-clavulanate and Ceftriaxone, which represented the 36.0% and 25.0% of all antibiotic prescription, respectively. Antibiotics may negatively affect the economic cost of hospitalization and the prescription is not always in accordance to guidelines, with potential important repercussions on the development of antimicrobial resistance. Actually, resistance to antibiotics is considered a major risk to the future health of the world population as it may lead to longer hospital stay, increased risk of mortality, health care costs and treatment failures.
Conclusion:
Strategies to reduce economical cost, hospitalization length and antimicrobial resistance include ensuring appropriate prescription and administration of empiric antibiotics as well as reducing the circulation of preventable infectious diseases through immunization.
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