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70% of infants given antibiotics for bronchiolitis had no bacterial coinfection
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A quarter of children aged younger than 2 years with bronchiolitis who visited U.S. EDs between 2007 and 2015 received antibiotics, even though 70% of those patients had no bacterial coinfection, according to study results published in the Journal of Pediatric Infectious Diseases Society.
“Bronchiolitis is a viral infection that does not respond to or require antibiotic treatment, and guidelines of the AAP, first published in 2006 and reiterated in 2014, recommend against the use of antibiotics for this illness,” Brett Burstein, MD, PhD, MPH, FRCPC, FAAP, told Infectious Diseases in Children. “Also, since 2013, reducing antibiotic prescribing for viral respiratory illness, including bronchiolitis, has become the top priority of the AAP’s Choosing Wisely national campaign. Despite these recommendations, we found that rates of antibiotic use did not decrease significantly in the decade following the guidelines.”
Burstein, who is an assistant professor of emergency medicine at McGill University, said the use of chest radiography was the most important predictor associated with antibiotic prescribing. In a study published in JAMA, Burstein and colleagues previously reported that radiographs were used to evaluate almost half of all bronchiolitis cases in infants diagnosed in American EDs — despite recommendations against their use.
In their most recent study, Burstein and colleagues conducted a secondary analysis of data from the National Hospital Ambulatory Medical Care Survey from 2007 to 2015. The survey was conducted at approximately 30,000 ED visits to 300 randomly selected U.S. EDs. Children aged younger than 2 years with a discharge diagnosis of bronchiolitis were included in the study. The primary outcome was the proportion of children with bronchiolitis who had no concomitant bacterial infection and were prescribed antibiotics in the ED.
Six hundred-twelve children (1.1%) met criteria to be included in the study — representing an estimated 2.92 million ED visits for bronchiolitis in children aged younger than 2 years in the U.S. The children had a median age of 8 months.
The researchers reported that at least one additional diagnosis consistent with bacterial infection was found in 11.9% of the patients, with the most frequent bacterial coinfection being acute otitis media.
Burstein and colleagues wrote that 25.6% of the patients in the study received antibiotics, which is an estimated 83,000 prescriptions annually. They also reported that 69.9% of the infants receiving antibiotic treatment did not have a documented concomitant bacterial infection. Penicillin (37.9%) and macrolides (37.7%) were the most commonly prescribed classes of antibiotics — a “surprising finding,” Burstein said, considering that macrolide antibiotics are rarely first-line therapy for any indication in this age group.
“So, in addition to overprescribing, inappropriate antibiotic selection must be addressed,” he said. “Targeted interventions are necessary to translate these guidelines into practice, particularly among nonacademic hospitals, where most infants with bronchiolitis are evaluated and where the use of antibiotics was found to be higher.” – by Bruce Thiel
References:
Burstein B, et al. JAMA. 2018;doi:10.1001/jama.2018.9245.
Papenburg J, et al. J Pediatr Infect Dis Soc. 2019;doi10.1093/jpids/piy131:
Ralston SL, et al. Pediatrics. 2014;doi:10.1542/peds.2014-2742.
Disclosures: The authors report no relevant financial disclosures.