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Hospitalized children with dengue often given unnecessary antibiotics
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Children who are hospitalized with dengue are frequently administered unnecessary antibiotics for presumed bacterial coinfections, according to findings published in PLoS Neglected Tropical Diseases. The findings reveal another potential target for antimicrobial stewardship.
Riyadi Adrizain, from Padjadjaran University in Indonesia, and colleagues wrote that many children with dengue are hospitalized because the clinical signs and symptoms of infection can vary widely in severity and the outcomes can be unpredictable. Previous research demonstrated that hospitals often administer unnecessary antibiotics, and Adrizain and colleagues hypothesized that some children with dengue may receive these unnecessary antibiotics.
The researchers examined the prevalence, indication and choice of antibiotics administered to children aged younger than 15 years. Patient and epidemiologic information was gathered using medical records of hospitalized patients who were admitted between Jan. 1 and Dec. 31, 2015, in the municipality of Bandung, Indonesia.
During the study period, 3,078 children with dengue were hospitalized, with 176 admitted to teaching hospitals and 2,902 admitted to private hospitals. The researchers found that 17.5% of all children hospitalized with dengue received antibiotics.
In teaching hospitals, one child had presumed bacterial upper respiratory tract infection (URTI), and six children had typhoid coinfection. Private hospitals reported more bacterial coinfections, including presumed bacterial URTI (n = 324; 11.2%), typhoid (n = 188; 6.5%) and UTI (n = 18; 0.6%). The prevalence of bacterial coinfection was significantly lower in teaching hospitals for both URTI (P < .0001) and typhoid (P < .05).
Adrizain and colleagues identified one patient in the teaching hospitals who received amoxicillin, whereas third-generation cephalosporins were given to 67% of cases in private hospitals. Most of the cephalosporins were given intravenously.
All children diagnosed with typhoid while they were treated for dengue in teaching hospitals had confirmation with either culture (n = 1) or a reactive immunoglobulin M anti-Salmonella test (n = 5). Most children with dengue and typhoid who were treated in private hospitals did not have laboratory confirmation (60.6%; n = 114), but IgM anti-Salmonella (6.5%; n = 13) and single Widal tests (32.5%; n = 61) were used for some patients. Most children diagnosed with typhoid in both types of hospitals were treated with third-generation cephalosporins.
Diagnoses for UTI were made using leucocyturia alone for most cases in private hospitals (61.1%; n = 11). The remaining patients with dengue who tested positive for UTI did so through a positive esterase and nitrate in urine dipstick test (38.9%; n = 7). Nearly all children with UTI were treated with third-generation cephalosporins (83.3%; n = 15), whereas amoxicillin, chloramphenicol and clarithromycin were each given to one child.
Adrizain and colleagues concluded that “both the indication and the choice of antibiotics” in hospitalized children with dengue infection and presumed bacterial coinfection were inappropriate in most cases — especially in private hospitals.
“Perhaps the single most important action needed to greatly slow down the development and spread of antibiotic-resistant bacteria is to change the way antibiotics are used,” they wrote. – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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