Impact of multiplex PCR respiratory viral panel testing on antibiotic utilisation in children with acute febrile and respiratory illnesses
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Updated: Jan 9, 2026
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Published on: November 10, 2023
Praveena Nediyara Bhaskaran1, Merlin Moni2, Dipu T T Sathyapalan2
1Department of Pediatric Infectious Diseases, Amrita Vishwa Vidyapeetham, Amrita Health Sciences Campus, Kochi, Kerala, India drpraveenabhaskar@gmail.com.
Insights
Respiratory virus panels (RVP) show potential for antibiotic stewardship in pediatric patients with influenza or acute febrile illness. However, overall antibiotic use reduction was minimal in low-resource settings.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Molecular diagnostics
Background:
- Antibiotic overuse is a significant concern in pediatric respiratory illnesses, particularly in low- and middle-income countries.
- The effectiveness of PCR-based respiratory virus panels (RVP) in curbing this overuse is not well-established.
Purpose of the Study:
- To evaluate the impact of RVP testing on antibiotic utilization in hospitalized children with febrile and respiratory illnesses.
- To identify factors influencing antibiotic duration and discontinuation post-RVP testing.
Main Methods:
- Retrospective analysis of 210 pediatric inpatients tested with RVP within 48 hours of admission (January 2021 - December 2022).
- Primary outcome: impact of RVP on total antibiotic duration.
- Secondary outcomes: antibiotic discontinuation rates and duration in subgroups; zero-inflated negative binomial regression for predictor analysis.
Main Results:
- 152 (72.3%) patients tested positive for at least one virus.
- Antibiotics were discontinued in 42% of patients following a positive RVP result.
- A positive RVP showed minimal overall reduction in antibiotic use, but significantly decreased antibiotic days for influenza patients and those with viral acute febrile illness.
- Pneumonia and PICU stay were associated with prolonged antibiotic use despite RVP positivity.
Conclusions:
- RVP testing can serve as an effective antibiotic stewardship tool in specific pediatric subgroups, including influenza and viral acute febrile illness.
- Further research is needed to optimize RVP utility in broader pediatric respiratory illness management in resource-limited settings.
Background:
The utility of a PCR-based respiratory virus panel (RVP) in limiting antibiotic overuse in paediatric febrile and respiratory illnesses in low- and middle-income countries remains unclear.
Methods:
This retrospective study included inpatients who underwent RVP testing within 48 hours of admission between January 2021 and December 2022. The primary outcome was the impact of the respiratory viral panel result on total duration of antibiotics. The secondary outcome was discontinuation of antibiotics following test results and duration of antibiotics in specific subgroups. A zero-inflated negative binomial (ZINB) regression identified predictors of outcome.
Results:
Of the 210 cases, 152 (72.3%) tested positive for ≥1 virus. 42% of patients had their antibiotics discontinued after getting a positive result. Overall, we noted a minimal effect of a positive RVP result in reducing antibiotic utilisation. However, in influenza patients, we observed a significant decrease in median antibiotic days compared with those with negative RVP (3 days (IQR 0-5.5) vs 6 days (IQR 2.25-8); p=0.011). Patients with acute febrile illness with viral aetiology received fewer days of antibiotics compared with those with negative RVP (2.5 days (IQR 0-5) vs 5 days (IQR 2-7); p=0.035). ZINB regression analysis showed that pneumonia patients (OR=1.27; p=0.03) and those with paediatric intensive care unit stay (1.2; 0.02) had higher odds of prolonged antibiotic use despite RVP positivity.
Conclusion:
In our setting, RVP reduced antibiotic use in specific subgroups like influenza-positive patients and those with acute febrile illness and could be potentially used as an antibiotic stewardship tool in these settings.
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