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Antibiotic Use in Pediatric Dengue Cases in Taiwan: A National Administrative Database Analysis
Yi-Jung Shen1,2, Chia-En Lien3, Yiing-Jenq Chou3,4
1Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Insights
Many children with dengue without bacterial infection unnecessarily receive antibiotics. This antibiotic use increases adverse drug events (ADEs), emergency visits, hospitalizations, and medical costs for pediatric dengue patients.
Area of Science:
- Infectious Diseases
- Pediatrics
- Pharmacovigilance
Background:
- Nonspecific clinical presentations of dengue fever often lead to misdiagnosis and unnecessary antibiotic prescriptions in pediatric patients.
- Antibiotic use in viral infections like dengue can result in adverse drug events (ADEs) and increased healthcare utilization.
Purpose of the Study:
- To investigate the patterns of antibiotic use in confirmed pediatric dengue cases without bacterial infection.
- To analyze the association between antibiotic use and healthcare utilization, medical costs, and ADEs in pediatric dengue patients.
Main Methods:
- Retrospective analysis of Taiwanese national administrative databases (2009-2015).
- Propensity score matching was used to compare children with confirmed dengue who received antibiotics versus those who did not.
- Regression models were employed to assess ADEs and medical care expenditures within a 30-day follow-up period.
Main Results:
- 28.2% of pediatric dengue patients without bacterial infection received antibiotics.
- Antibiotic recipients showed significantly higher odds of emergency department visits (OR: 3.16) and hospitalizations (OR: 4.20).
- Antibiotic use was linked to increased odds of overall ADEs (OR: 1.72), dermatologic-related ADEs (OR: 1.83), and gastrointestinal-related ADEs (OR: 1.67), along with higher medical costs.
Conclusions:
- A significant proportion of pediatric dengue cases without bacterial infection are treated with potentially avoidable antibiotics.
- Antibiotic prescription in this population is associated with increased adverse drug events, healthcare utilization, and medical expenditures.
- These findings highlight the need for improved diagnostic accuracy and antibiotic stewardship in managing pediatric dengue.
Abstract:
Nonspecific dengue clinical manifestations lead to avoidable antibiotic use. We describe antibiotic use in confirmed pediatric dengue cases and associated healthcare utilization and medical costs, including from antibiotic-associated adverse drug events (ADEs). From Taiwanese national administrative databases, children with confirmed dengue between 2009 and 2015 who were younger than 18 years old, without bacterial infection, and who were prescribed antibiotics a week before or after laboratory diagnosis were propensity score matched and compared with nonrecipients, using regression models for ADEs and medical care expenditures. A total of 1,959 out of 6,938 children (28.2%) with confirmed dengue without bacterial infection received antibiotics. Recipients were more likely to incur emergency department visits (odds ratio [OR]: 3.16; 95% CI: 2.62-3.81), hospitalizations (OR: 4.20; 95% CI: 3.48-5.07), and higher predicted medical care expenditures (new Taiwan dollar [NTD] $16,914 versus NTD $14,104) in a 30-day follow-up period. They also had significantly higher odds of overall defined (OR: 1.72; 95% CI: 1.42-2.09), dermatologic-related (OR: 1.83; 95% CI: 1.36-2.46), and gastrointestinal-related (OR: 1.67; 95% CI: 1.31-2.12) ADEs. A substantial proportion of pediatric patients with dengue received potentially avoidable courses of antibiotics. Recipients were more likely to experience ADEs, incurring more medical care utilization and expenditures than untreated cases.
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