Antibiotic use and class absenteeism in children with influenza-like-illness in an emergency department
Nicole M Poole1, Angela Moss2, Krithika Suresh3,4
1Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, 80045, USA. nicole.poole@cuanschutz.edu.
Insights
Antibiotic use in children with influenza-like-illness (ILI) did not reduce missed school days or illness duration. This study highlights that prescribing antibiotics for ILI may not offer benefits for absenteeism or recovery time.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Public Health
Background:
- Children with influenza-like-illness (ILI) are often prescribed antibiotics to return to school or childcare.
- This practice contributes to antibiotic overuse and raises questions about its efficacy.
Purpose of the Study:
- To investigate the association between antibiotic receipt for ILI during an Emergency Department (ED) visit and subsequent class absenteeism and illness duration.
- To address social drivers of antibiotic overprescribing in pediatric respiratory infections.
Main Methods:
- Secondary analysis of 251 children (2 months to 12 years) with uncomplicated ILI discharged from an ED.
- Primary exposure: antibiotic receipt during the illness course, assessed via chart review and follow-up surveys.
Main Results:
- Antibiotic use (n=65) was not significantly associated with increased or decreased class absenteeism (IRR: 1.14) or illness duration (IRR: 1.06) compared to non-antibiotic users (n=186).
- Patients receiving antibiotics missed a median of 3 days of class and had 5 days of illness, versus 2 days of class and 4 days of illness for those not receiving antibiotics.
Conclusions:
- Antibiotic prescription for ILI in children does not appear to reduce class absenteeism or illness duration.
- Findings suggest that antibiotic use for ILI may not be beneficial for these outcomes, challenging common clinical practices influenced by return-to-class concerns.
Background:
Children with influenza-like-illness (ILI) often require clinician clearance or antibiotics to return to child care or school. Study objectives were to examine the association between antibiotic receipt during an Emergency Department (ED) visit for ILI and the outcomes of class absenteeism and illness duration.
Methods:
A secondary analysis of 251 children aged 2 months to 12 years with uncomplicated ILI discharged from the ED from December 1, 2018 to November 30, 2019 was conducted. The primary exposure was receipt of antibiotics over the course of illness (assessed by chart review and family follow-up survey).
Results:
Patients prescribed antibiotics (n = 65) experienced a median of 3 (interquartile range [IQR]: 1,5) days of class missed and 5 (IQR: 3,7) days of illness compared to 2 (IQR: 1,4) days of class missed and 4 (IQR: 3,7) days of illness for those not prescribed antibiotics (n = 186, p = 0.08 and p = 0.13, respectively). There was no statistically significant association with missed class days (incidence rate ratio [IRR]: 1.14 [0.86-1.50], p = 0.37) or days of illness (IRR: 1.06 [0.88-1.27], p = 0.55) for patients prescribed antibiotics compared to patients not prescribed antibiotics for ILI.
Conclusions:
Antibiotic use for ILI was not associated with reduced class absenteeism or illness duration.
Impact Statement:
Child care centers and schools sometimes exclude children with influenza-like-illness (ILI) from class until cleared to return by a clinician and/or prescribed antibiotics. This study addresses these social drivers of overprescribing. Antibiotics were prescribed in 26% of children with ILI discharged from a large Emergency Department in the US. Antibiotic use was not significantly associated with class absenteeism or illness duration. This study can serve as a discussion point for clinicians when navigating parental or social pressures to prescribe antibiotics for uncomplicated acute respiratory tract infections, particularly when these pressures are influenced by concerns about returning to class.
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