Antibiotics for Pediatric Patients With Laryngotracheobronchitis in Korea: A Nationwide Study Based on Administrative
Seung Beom Han1,2, Kil Seong Bae1,3, Ui Yoon Choi1,3,4
1Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Insights
Unnecessary antibiotic prescriptions for pediatric croup in Korea are common, particularly in hospitals and clinics. Antimicrobial stewardship programs should target physicians in these settings to combat antimicrobial resistance (AMR).
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Public health
Background:
- Antimicrobial resistance (AMR) poses a significant global health threat.
- Laryngotracheobronchitis (croup), a common childhood respiratory infection, is often viral and does not require antibiotics.
- Reducing unnecessary antibiotic use in acute respiratory infections (ARIs) through antimicrobial stewardship programs (ASPs) is crucial for combating AMR in children.
Purpose of the Study:
- To investigate antibiotic prescription patterns in pediatric patients diagnosed with laryngotracheobronchitis in Korea.
- To identify factors associated with antibiotic prescribing for this condition.
- To provide data for improving pediatric antimicrobial stewardship programs (ASPs) in Korea.
Main Methods:
- Analysis of outpatient prescriptions for children aged ≤ 5 years with International Classification of Disease, 10th Revision codes for laryngotracheobronchitis (J050, J040, J041) from 2017-2020.
- Extracted demographic and medical facility information for each prescription.
- Estimated overall antibiotic prescription rates and conducted multivariable analysis to identify associated factors.
Main Results:
- Out of 2,358,194 prescriptions, 35.2% included antibiotics.
- Hospital management (aOR, 22.33) and clinic management (aOR, 12.66) were strongly associated with antibiotic prescriptions.
- Antibiotic use was higher in younger children (≤ 2 years), those seen by pediatric specialists, and in non-metropolitan areas. Extended-spectrum penicillins were most common.
Conclusions:
- Antimicrobial stewardship programs (ASPs) should prioritize physicians in hospitals, clinics, and pediatric specialties.
- Educational interventions targeting these groups can enhance awareness of AMR and appropriate antibiotic use.
- These strategies may effectively reduce unnecessary antibiotic prescriptions for pediatric laryngotracheobronchitis, thereby mitigating AMR in children in Korea.
Background:
Antimicrobial resistance (AMR) is an important global public health concern in adults and children. Laryngotracheobronchitis (croup) is a common acute respiratory infection (ARI) among children, most often caused by a virus, and should not be treated with antibiotics. Reducing the usage of unnecessary antibiotics in ARI using an antimicrobial stewardship program (ASP) is an effective measure against AMR in children. This study investigates the antibiotic prescription pattern in pediatric patients with laryngotracheobronchitis in Korea. Our results will be useful to improve the ASP.
Methods:
The data were obtained from the government agency Health Insurance Review and Assessment Service. We analyzed outpatient prescriptions issued to children ≤ 5 years of age with a first-listed diagnosis code for laryngotracheobronchitis, i.e., International Classification of Disease, 10th Revision, code J050 (croup), J040 (laryngitis), or J041 (tracheitis), during 2017-2020. For each prescription, demographic information and information about medical facilities visited (type of hospital, specialty of physician, location of hospital) were extracted. The overall antibiotic prescription rate was subsequently estimated, and multivariable analysis was conducted to determine the associated factors of antibiotic prescription. Prescribed antibiotics were described and classified into extended-spectrum penicillins, cephalosporin, and macrolides.
Results:
Of 2,358,194 prescriptions reviewed, 829,172 (35.2%) contained antibiotics. In the multivariable analysis, management in a hospital was the strongest factor associated with antibiotic prescription (adjusted odds ratio [aOR], 22.33; 95% confidence interval [CI], 20.87-23.89; P < 0.001), followed by management in a clinic (aOR, 12.66; 95% CI, 11.83-13.54; P < 0.001) and management in a general hospital (aOR, 8.96; 95% CI, 8.37-9.59; P < 0.001). Antibiotic prescription was also significantly associated with patients who were ≤ 2 years of age, managed by a pediatric specialist, and treated at a hospital located in a non-metropolitan region. Overall, extended-spectrum penicillins were the most frequently prescribed (18.6%) antibiotics, followed by cephalosporins (9.4%) and macrolides (8.5%).
Conclusion:
The results of our study suggest that ASPs need to focus on physicians in hospitals, clinics, general hospitals, and pediatric specialties. Providing education programs to these groups to increase awareness of AMR and appropriate antibiotics use could be effective ASP policy and may help to reduce unnecessary prescriptions of antibiotics for laryngotracheobronchitis among pediatric patients and therefore potentially AMR in children in Korea.
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