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Viral testing key to reducing inappropriate antibiotic use
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Viral testing may reduce unnecessary antibiotic prescriptions for children aged younger than 3 years, according to study findings published online.
From February 2007 to 2010, Joshua M. Colvin, MD, of the department of pediatrics at Washington University School of Medicine in St. Louis, and colleagues enrolled 75 children aged 2 to 36 months who presented to the ED with fever of unapparent source.
Colvin and colleagues reported that one or more viruses were isolated from 76% of the 75 patients, and 51% of these patients were treated with antibiotics. Thirty-four percent of 146 viral infections were detected only by polymerase chain reaction performed on blood.
Adenovirus, enterovirus, human herpesvirus 6, and parechovirus were the most common viruses detected in this study.
The researchers said there were some study limitations, such as enrollment was limited to those children who were having blood drawn, limiting the generalizability of the results.
“Testing of blood in addition to nasopharyngeal secretions expanded the range of viruses detected. Future studies should explore the utility of testing for the implicated viruses,” the researchers concluded.
Gregory Storch
“Fever without a source is a common problem in pediatrics. Since the introduction of vaccines for Haemophilus influenzae type b and Streptococcus pneumoniae, bacteremia accounts for the illness in less than 1% of cases. Urinary tract infections account for 5-10%, but the cause of the remaining cases has not been carefully been defined,” lead author of the study Gregory Storch, MD, director, divisions of pediatric infectious diseases and pediatric laboratory medicine, St. Louis Children's Hospital, told Infectious Diseases in Children. “Using advanced molecular methods, we showed that pathogenic viruses are present in the majority of remaining cases. Many of these can be detected in the blood. We are hopeful that better understanding of the viral causes of fever without a source will help limit unnecessary antibiotic use.”
Disclosure: The researchers report no relevant financial disclosures.
Gregory Storch, MD, can be reached at St. Louis Children’s Hospital, 1 Children’s Place, St.Louis, Missouri 63110; email: storch@wustl.edu.
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